JOHNA.SEAVERNS 


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STUDIES    IN 


CLINICAL  VETERINARY  MEDICNE 
AND  SURGERY 


BY 

P.  J.  CADIOT 

Professor  of  Surgery  at  the  Veterinary  School  of  Alf or t;  late  President  of 
the  Central  Society  of  Veterinary  Medicine  of  Paris 


TRANSLATED.    EDITED,    AND    SUPPLEMENTED 
WITH  49   NEW   ARTICLES    AND    34    ILLUSTRATIONS 


BY 

JNO.   A.    W.   DOLLAR,   M.R.C.V.S. 

Corresponding  Member  of  the  Central  Society  of  Veterinary  Medicine  of  Paris; 

Life  Member  of  the  Royal  Italian  Society  of  Hygiene; 

Corresponding  Associate  of  the  Royal  Spanish  Society  of  Hygiene; 

Corresponding  Member  of  the  Society  of  Veterinary  Medicine  of  Brabant  {Belgium); 

Honorary  Associate  of  the  Spanish  Society  of  Arts;  etc. 


NEW  YORK : 

WILLIAM  R.  JENKINS 

VETERINARY  PUBLISHER  AND  BOOKSELLER 

85 1  AND  853  Sixth  Avenue 

1904 


TO 
VICTOR     HORSLEY 

Zh\6  worh  16,  witb  permiseion,  ^e^icate^ 

AS    A 

TOKEN     OF     RESPECT     AND     GRATITUDE 

BY 

THE   TRANSLATOR   AND    CO-AUTHOR. 


BY  THE  SAME  AUTHOR. 


Royal  Sfo,  438  pages,  406  illustrations. 

A    HANDBOOK    OF    HORSE-SHOEING, 

With  Introductory  Chapters  on  the  Anatomy  and 

Physiology  of  the  Horse's  Foot,  and  54  full-page 

plates  with  descriptive  notes  bv  Albert  Wheatiey, 

F.R.C.V.S.' 


60  large  pages  (14^  x  10  inches),  315  illustrations. 

AN  ATLAS  OF  VETERINARY  SURGICAL 

OPERATIONS. 


Demy  Svo,  42  pages,  16  full-page  plates. 

A    SURGICAL     OPERATING     TABLE    FOR 

THE    HORSE. 


Royal  Svo,  732  pages,  142  illustrations. 

MOLLER'S  VETERINARY  SURGERY, 

Translated    from    the    last    German    edition   and 

Edited  by 

JNO.    A.    W.    DOLLAR,    M.R.C.V.S. 


PREFACE. 


Notwithstanding  the  general  consensus  of  opinion  in  favour  of 
clinical  teaching,  this  method  of  instruction  has  until  recently  been 
somewhat  neglected  in  British  veterinary  schools.  In  Germany,  on 
the  other  hand,  ambulatory  cliniques  occupied  an  important  position 
from  a  very  early  date,  and  in  the  two  great  French  schools  of  Lyons 
and  Alfort  clinical  demonstrations  have  received  an  extension  and 
been  brought  to  a  pitch  of  perfection  probably  unsurpassed  elsewhere. 

Convinced  from  my  student's  days  of  the  value  of  this  system  I 
was  greatly  attracted  by  the  impromptu  lectures  at  Alfort,  and  early 
began  the  collection  of  extensive  notes,  and  in  some  cases  of  drawings, 
designing  on  my  return  home  to  publish  a  small  clinical  volume. 
Pressure  of  literary  and  other  work  unfortunately — or  perhaps  fortu- 
nately— rendered  this  impossible.  Meanwhile  Professor  Cadiot,  one  of 
the  foremost  clinical  teachers  in  France,  whose  instruction  I  consider 
myself  fortunate  in  having  received,  gave  a  renewed  impulse  to  my 
purpose  by  the  publication  last  year  of  his  '  Etudes  de  Pathologie  et 
de  Clinique.'  A  glance  at  this  admirable  work  convinced  me  that  in 
great  part  at  least  my  work  had  been  anticipated,  and  that  instead  of 
pursuing  my  original  intention  I  should  better  serve  the  interests  of 
English-speaking  colleagues  by  assuming  the  humble  but  (from  their 
standpoint)  no  less  useful  part  of  translator,  utilising  my  own  material 
and  that  to  be  derived  from  English  literature  by  way  of  supplement 
to  the  experiences  of  my  former  teacher. 

On  this  conviction  I  have  acted.     The  first  part  of  the  original 


PREFACE. 


work,  together  with  certain  chapters  considered  of  minor  interest^ 
have  been  omitted  ;  forty-nine  new  articles  have  been  added,  and  the 
number  of  illustrations  has  been  nearly  doubled. 

To  Professor  Cadiot,  who  has  extended  to  me  every  assistance  in 
his  power,  I  hereby  express  my  liveliest  gratitude ;  while  for  the  un- 
failing patience  and  friendly  sympathy  with  which  Professor  McQueen, 
of  the  Royal  Veterinary  College,  London,  has  carried  through  the 
task  of  reading  the  proof-sheets  of  the  present  work  I  desire  to  tend^ 
him  my  sincerest  thanks. 

JNO.  A.  W.  DOLLAR. 


56,  New  Bond  Street,  London,  W.  ; 
September  2gtJi,  1900. 


CONTENTS. 


PART    I. 


SURGICAL    PATHOLOGY    AND    PRACTICE. 

page: 

I.  Dentigerous  cysts  in  the  temporal  region  .  .  .  .  i 

II.  Purulent  collections  in  the  facial  sinuses  and  dental  caries  .  .  8 

III.  Affections  of  the  turbinated  bones  in  the  horse     .  .  •  •  '5 

IV.  Tumours  in  the  facial  sinuses  and  cancer  of  the  superior  maxilla  .         22 
V.  The  surgical  treatment  of  chronic  roaring               .             .             .  .3*^ 

VI.  Acute  inguinal  hernia  .....••         35 

VII.  Deep-seated  inguinal  abscess  after  castration         .  .  .  .40 

VIII.  Diaphragmatic  hernia  .....••         44 

IX.  Blennorrhoea  in  the  dog       .....••         5^ 

X.  Amputation  of  the  penis  in  the  horse  .  .  .  .  .56 

XI.  Radial  paralysis  in  the  horse  ......         64 

XII.  The  treatment  of  spavin      .......         72 

XIII.  The  treatment  of  picked-up  nail     ......         78 

XIV.  Plantar  neurectomy  .......         86 

XV.  Neurectomy  of  the  median  and  of  the  ulnar  nerves  .  .  .92 

XVI.  Lymphangitis  and  multiple  abscesses  in  the  horse,  due  to  the  presence 

of  staphylococci  .......         97 

XVII.  External  tuberculosis  in  the  dog  and  cat    .....       lOO 

XVIII.  A  case  of  sarcomatous  disease        ......        106 


PART    II. 

MEDICAL    PATHOLOGY    AND    PRACTICE. 


XIX.  Acute  endocarditis  in  the  horse 

XX.  Aortic  insufficiency  in  the  horse 

XXI.  Mitral  insufficiency  in  the  horse 

XXII.  Myocarditis 

XXIII.  Ossification  of  the  cardiac  auricles 

XXIV.  Cardiac  intermittency  in  the  horse 
XXV.  Pericarditis  in  the  dog 

XXVI.  Pneumonia  in  the  horse 

XXVIl.  Pneumonia  in  the  horse  (conclusion) 


ii6 

125 
132 
142 
153 
157 
162 
170 
i8s 


nil 


CONTENTS. 


XXVIII.  Chronic  pleurisy  in  the  horse 

XXIX.  The  abdominal  form  of  influenza  in  the  horse 

XXX.  A  case  of  pharyngitis  due  to  strangles 

XXXI.  Tuberculosis  in  the  horse    .... 

XXXII.  Tuberculosis  in  the  dog        .... 

XXXIII.  Tuberculosis  in  the  cat        .... 

XXXIV.  Hjemoglobinuria  (azoturia)  in  the  horse 

XXXV.  Hsemoglobinuria  (azoturia)  in  the  horse  (conclusion) 

XXXVI.  Diabetes  mellitus  in  the  dog 

XXXVII.  Exophthalmic  goitre 

XXXVIII.  Eczema  in  the  dog 

XXXIX.  Eczema  in  the  dog  (conclusion) 

XL.  Eczema  in  the  horse 


P.\UE 

202 
210 
219 

225 

234 
244 
249 

257 
264 
272 
279 
286 
291 


PART    III. 

CLINICAL    CASES. 

I. — Head  and  Spinal  Cord. 

A.  Cranium,  brain,  and  spinal  cord. 

Supernumerary  tooth  in  the  temporal  region  —  operation  —suppurating  median 
otitis         ........ 

Tumour  of  the  right  hemisphere  of  the  brain 

Tumour  of  the  cerebellum     ...... 

Tumour  of  the  brain  in  the  horse     ..... 

Brain  disease — tumour -in  neighbourhood  of  cerebellum  and  medulla 
Cerebral  injury  and  Cheyne-Stokes  respiration  in  a  horse 
Tumour  of  the  vertebral  column        ..... 

B.  Eye  and  ear. 

Cancer  of  the  lower  eyelid  and  globe  of  the  eye 

Malignant  carcinomatous  intra-orbital  growth  with  destruction  of  the  eye  in  a 

cow-         .    •         . 
Traumatic  cataract    ....... 

Cataract— operation  ... 

Symbiotic  acariasis  and  eczema  of  the  ear  .... 

C.  Nose  and  nasal  cavities. 

Necrosis  of  the  nasal  septum  ..... 

Necrosis  of  the  cartilage  of  the  left  nostril   .... 

Sebaceous  cysts  in  the  false  nostril  ..... 

Chronic  inflammation  and  necrosis  of  the  posterior  (maxillary)  turbinated  bone 
Tumours  in  the  nasal  cavities  ..... 

Purulent  inflammation  of  the  sinuses;   meningo-encephalitis 
D.  Lips. —  Cheek. — Jaws. — Mouth.  —  Pharynx. 
Pseudo-cancroid  of  the  lip      . 
Papillary  sarcoma  of  the  cheek  ..... 

Fracture  of  the  lower  jaw       ...... 

Ostitis  of  the  inferior  maxilla  — necrosis  — sequestrum 

Cancer  of  the  inferior  maxilla  ..... 

Dental  caries  ....... 

Dental  fistula  ....... 


298 
300 
303 
304 
304 
307 
308 

309 

310 

3>i 
312 
312 

314 
315 
316 
317 
319 
323 

324 
326 

326 

327 
328 

330 

331 


CONTENTS. 


IX 


Section  of  the  tongue  . 

Foreign  body  in  the  mouth    . 
Chronic  pharyngitis — double  hyovertebrotomy 
Cold  abscess  in  the  retro-pharyngeal  glands 


PAGE 

333 
334 
335 
336 


II. — Neck. 

Wound  of  the  neck     .........  338 

Poll-evil  ...,..,...  339 

Sinus  of  the  neck        .........  340 

Moist  gangrene  in  the  neck   ........  340 

Phlebitis  of  the  jugular  vein  ........  341 

Extensive  lacerated  wound  in  neck  of  horse;  rupture  of  the  trachea;  recovery     .  344 

Foreign  body  in  the  oesophagus         .......  345 

Foetid  abscess  in  the  neck  of  a  cat  caused  by  a  needle  ....  347 

Surgical  treatment  of  chronic  roaring  ......  347 


III. — Thorax. 

Fistulous  withers         ...... 

Abscess  in  the  left  costal  region — necrosis  of  the  last  rib    . 

Fracture  of  the  first  rib  in  the  horse 

Myoma  of  the  oesophagus       ..... 

Chronic  endocarditis  ..... 

Myocarditis — cardiac  intermittency 

Hydatid  cyst  of  heart  ..... 

Intra-mural  cardiac  abscess  in  a  cow 

Foreign  body  in  the  pericardium — intra-pericardial  haemorrhage 

Rupture  of  the  right  ventricle  in  the  horse    . 

Rupture  of  the  pulmonary  artery       .... 


354 
357 
357 
358 
359 
361 

364 
365 
365 
366 
366 


IV. — Abdomen  and  Tail. 

Necrosis  of  aponeurotic  tissues  in  the  flank 

Hernia;  .... 

Cancer  of  the  stomach 

Abscess  of  the  liver  in  the  horse 

Intestinal  obstruction 

Perforation  of  the  intestine    . 

Subcapsular  haemorrhage  in  the  liver  of  the  horse ;    partial    recovery ; 

and  death 
Chylous  ascites  in  the  cat;  meningitis  as  an  accompaniment 
Constipation  .... 
Foreign  body  in  the  rectum   . 
Rupture  of  the  posterior  aorta 
Thrombosis  of  the  iliac  arteries  in  the  horse 
Acute  nephritis 
Cancer  of  the  kidney 
Diseased  prostate  in  the  dog 
Cryptorchid  operations 
Cryptorchidism  in  the  cat 


relapse 


368 
369 
374 
376 
377 
378 

379 
380 

384 
385 
386 

387 
388 

389 
391 
397 
404 


CONTENTS. 


Cancer  of  the  scrotum  .... 

Cancer  of  the  testicle — unsuccessful  attempt  to  inoculate 

Spermatic  aneurysmal  varix  in  the  ox 

Scirrhous  cord  with  urethral  obstruction  in  the  horse  ;  operation  ; 

Necrosis  of  the  penis 

Cancer  of  the  penis    . 

Paralysis  of  the  penis 

Atrophy  of  the  penis 

Calculus  in  the  urethra 

Urethrotomy  for  removal  of  calculus  in  a  horse 

Nymphomania — ovariotomy 

Hysteria  in  a  mare 

Prolapsus  vaginae  in  a  young  mare 

Cystic  degeneration  of  the  ovary  and  Fallopian  tube 

Prolapse  of  the  uterus 

Myxoma  of  the  uterus 

Imperforate  vagina     . 

Amenorrhcea  due  to  imperforate  hymen 

Epithelioma  of  the  vulva 

Rupture  of  the  perinseum — operation 

Cancer  of  the  tail — generalisation  after  ablation 


recovery 


PAGE: 

405 
40s. 
408 
408. 
409 

4IO' 

411 
414 
414 
415. 

416 

417- 
418. 
421 

422: 
423. 
423 
424. 
424. 
426 
427 


V. — The  Limbs. 

Ossifying  periosteal  sarcoma  of  the  shoulder — generalisation 

Total  necrosis  of  the  scapula  ...... 

Disease  of  the  scapulo-humeral  articulation — necrosis  of  the  articular  cartilages 
Injury  of  the  flexor  brachii  muscle    ...... 

Fracture  of  the  humerus  in  a  horse  ...... 

Penetrating  wound  of  the  elbow         ...... 

Foreign  body  in  the  knee       ....... 

Suppurating  synovitis  of  the  carpal  sheath  ..... 

"  Luxation  "  of  the  patella     ....... 

Ossification  of  the  tendon  of  the  semi-tendinosus  muscle    . 

Fracture  of  the  tibia  in  a  horse  ...... 

Suppurating  lymphangitis — abscess  formation  in  the  popliteal  lymphatic  glands — 
treatment  with  hydroxy!  ...... 

Spavin  and  knuckling  over  at  the  fetlock     ..... 

Distension  of  tendon  sheaths  in  front  of  the  hock    .... 

Median  and  ulnar  neurectomy — after  complication 

Quittor — partial  necrosis  of  the  anterior  lateral  ligament  of  the  pedal  joint 

Operation  for  picked-up  nail  ...... 

Complicated  cases  of  corn     ....... 

Granuloma  on  foot  of  stallion  ...... 

Rupture  of  the  sesamoid  ligaments  in  both  fore-limbs 


429 
430- 
432 
433 
434^ 
435. 
436 
437 
438 
442- 
443. 

444- 
445 
446. 

447 

449. 

451 
455. 
457- 
461 


VI. — Infectious  Diseases. 

Tuberculosis  in  the  horse       ........       463: 

Tuberculosis  in    a  cow — inflammation  of   the    omasum    and  ulceration  of   the 

abomasum  .........       469^ 


CONTENTS, 


XI 


Tuberculosis  of  the  cerebrum  .... 

External  lesions  of  tuberculosis  in  the  dog  . 

Tuberculosis  in  the  cat  ..... 

Transmission  of  pulmonary  tuberculosis  from  man  to  the  cat 
Transmission  of  tuberculosis  from  man  to  the  paroquet 
Bothryomycosis  ...... 

Pneumonia      ....... 

Purpura  hsemorrhagica  ..... 

Tetanus  ....... 


PAGE 
470 

47' 

473 

475 

475 

477 

481 

498. 

498. 


VII. — Various  Diseases. 

Parasitic  anaemia  (ixodes)      ..... 

Echinococcosis  of  the  brain,  lungs,  and  liver  in  the  horse  . 
Paresis  of  the  hind  limbs  (chorea)     .... 

Rheumatism  ....... 

Rheumatism  or  pachymeningitis       .... 

Sarcomatous  disease  of  the  lung        .... 

Round-celled   sarcoma   of  the   right   testicle   with   enormous    i 
tumour  in  the  horse         ..... 

Carcinoma  of  the  kidney  in  the  horse 

Mammary  adenoma  in  the  bitch  with  pulmonary  metastasis 

Infective  granuloma  in  a  mare  .... 


504 

504 

Sio 

5" 

512 

515 

mtra-abdominal 

. 

S>6 

517 

517 

. 

519 

PART    IV. 

EXPERIMENTAL  AND  COMPARATIVE  PATHOLOGY 

I.  A  contribution  to  the  study  of  avian  tuberculosis 
H.  Tuberculosis  of  parrots— its  relation  to  human  tuberculosis 
in.  Experimental  tuberculosis  in  the  goat        .... 
IV.  Malignant  tumours  in  animals         ..... 


522: 

558 
575 
579 


PART    V. 

EXPERIMENTAL  THERAPEUTICS. 

I.  The  treatment  of  tuberculosis        ....... 

II.  The  serum  treatment  of  glanders  ....... 

III.  The  action  of  vanadine       ........ 

IV.  Intra-venous  injections  of  iodine  ....... 

Appendix — A  comparative  table  showing  the  approximate  equivalent  in  Fahrenheit 
scale  of  a  given  Centigrade  reading       ...... 

Index        .......•.•• 


595 
600 
604 
607 


614 
61S 


LIST     OF     ILLUSTRATIONS. 


Moist  gangrene  of  the  foot  after  plantar  neurectomy 
Neurectomy  of  the  ulnar  nerve  . 


Fig. 

1.  Pre-auricular  fistula  due  to  presence  of  a  dentigerous  cyst 

2.  Method  of  closing  the  communicating  orifice  between  the  mouth  and  maxillary 

sinus  left  after  punching  out  a  molar  tooth 

3.  The  same  as  Fig.  2.     Lower  (palatine)  surface 

4.  Necrosis  of  the  turbinated  bones 

5.  Pavement-celled  epithelioma  of  the  maxilla.     Transverse  section  of  the  face  in 

front  of  the  fifth  molar    . 

6.  Diaphragmatic  hernia 

7.  Amputation  of  the  penis 

8.  Neurotomy  of  the  anterior  tibial  nerve 

9- 
10. 
1 1. 
12. 

13.  Tuberculous  ulcer  in  the  throat 

14.  „  „      in  the  neck 

15.  „  ,,      of  the  nose 

16.  Chronic  endocarditis  of  the  aortic  valves 

17.  Chest  bandage 
i8.  Tuberculosis  of  the  liver 

19.  ,,  ,,  „      (atypical  form) 

20.  ,,  „         epiploon 

21.  Tuberculous  pneumonia.     Section  through  right  lung  showing  cavernous  spaces 

22.  Tuberculosis  of  the  tracheo-bronchial  and  mediastinal  glands 

23.  Brain  disease.     Position  at  rest 

24.  Brain  seen  from  left  side 

25.  Vertical  section  through  brain 

26.  Sarcoma  of  the  vertebral  column 
2*7.  Necrosis  of  the  nasal  cartilage 

28.  Sarcoma  of  the  nose   . 

29.  Cancer  of  the  inferior  maxilla 

30.  Internal  surface  of  the  right  branch  of  maxilla 

31.  Loop  of  thread  removed  from  dog's  tongue  . 

32.  Wound  of  the  neck     .... 


PAGE 
4 


27 
46 
61 
76 
76 

88 
95 
95 

lOI 
lOI 

104 
126 
168 
238 
239 
239 
245 
245 
305 
306 

307 
309 
315 
320 

328 
329 

334 
338 


LIST    OF    ILLUSTRATIONS. 


Fig 

33- 

34. 

35- 

36. 

37. 

38. 

39- 

40. 

41. 

42. 

43- 
44. 

45- 
46. 

47- 
48. 
49. 
50. 
51- 
52. 
33- 
54- 
55- 
56. 
57- 
.58. 

59- 
60. 
61. 
62. 
63- 
^4- 
65- 
66. 

-67. 
68 
69. 

70. 

71- 

72. 

73- 
74- 
75- 
76. 
76A 

77- 
78. 

79- 
80. 

81. 

S2. 


Lacerated  wound  of  the  neck,  etc. 
Fistulous  withers  (left  side)    . 

,.  i>       (right  side) 

Fractured  first  rib 
Chylous  ascites 
Chylous  fluid  , 

Microscopic  appearance  of  fresh  milk 
Diseased  prostate,  etc.,  naked-eye  appearance 
Prostate  of  dog.     General  structure  (microscopic  appearance) 

,,  ,,  Section  of  tumour 

„  „  „       of  calcified  portion  of  tumour 

Right  kidney  of  dog  ..... 
Epithelioma  of  the  testicle  (section) 

Amputation  of  penis,  showing  stump  and  urethraKorifice 
Prolapsus  vaginae  in  a  mare  .... 
Malignant  epithelioma  of  anus  and  vulva  in  a  cow 
Suture  for  rupture  of  perinseum 
'J'otal  necrosis  of  the  scapula 
Disease  of  the  scapulo-humeral  articulation 
Injury  of  the  flexor  brachii  muscle     . 
Fracture  of  the  humerus         .... 
Foreign  body  in  the  knee  of  a  dog    . 
Luxation  of  the  patella  (position  at  rest) 

,,  ,,  „  (position  during  movement) 

Fracture  of  the  tibia  in  a  horse 

Rupture  of  the  flexor  tendons,  etc.,  after  neurectomy 
Granuloma  on  coronet  of  stallion  (off-side  view) 

,,  ,,  „         (near-side  view)    . 

The  above  case  three  months  after  operation 
Paroquet  with  cutaneous  tuberculous  growths 
Bothryomycotic  swelling  of  the  shoulder 
Bothryomycosis  of  the  hock  . 
Echinococcosis.     Region  of  insensibility 
Liver  with  cysts 
Liver,  showing  cysts,  laid  open 
Right  lung,  showing  cysts 
Debris  in  cyst  fluid 
Echinococcus  scolex  . 
Brain,  showing  cysts  . 

Rheumatism  or  pachymeningitis  ?  attitude  when  quiescent 
,,  ,,  attitude  during  an  attai 

Malignant  granuloma  from  stomach 

„  „  from  lung 

Tuberculosis  of  the  liver  (fowl) 

Horny  growth  developed  on  a  tuberculous  patch  on  rheek 

Tuberculous  lesion  in  neighbourhood  of  eye 

Tubercle  from  liver  of  parrot 

Tuberculosis  of  crest  (parrot)  .  .  . 

Tuberculous  vegetations  on  head  (parrot) 


LIST    OF    ILLUSTRATIONS. 


XV 


Fig 

83- 
84. 

85. 
86. 
87. 
88. 
89. 
90. 
91. 
92. 

93- 

■94. 


Tuberculous  growth  in  left  ventricle  of  goat 
Epithelioma  of  the  mammary  gland  . 

Fusiform-celled  sarcoma  from  mammary  gland 
Chondroid  sarcoma  of  the  mammary  gland' 
Osteoid  sarcoma  of  the  mammary  gland 
Epithelioma  of  the  testicle     . 
,,  of  the  parotid     . 

Pavement  epithelioma  of  stomach 
Epithelioma  of  the  perianal  gland 
Sebaceous  epithelioma 
Fusiform-celled  sarcoma  of  the  vertebral  column 


PAGE 

577 

584 
584 
585 
586 

587 
587 
588 
588 
589 

589 
590 


TEMPERATURE   CHARTS. 


■Charts  I  and  II 

„  III  and  IV 

Chart  V    . 

„  VI. 

„  VII 

„  VIII 

.,  IX  . 


482 

483 
484 

485 
486 

491 
494 


COLOURED    PLATES. 


Heart  of  a  horse  dead  of  contagious  pneumonia.     Acute  myocarditis 
Tuberculous  infiltration  of  the  lung.     Section  of  right  lobe 
Sarcomatous  form  of  pulmonary  tuberculosis.     Section  of  left  lung 
Tuberculous  endocarditis  in  the  horse.     Left  ventricle  . 


TO  FACE 

PAGE 

142 

226 

.    228 

232 


CLINICAL  VETERINARY  MEDICINE 
AND  SURGERY. 


PART     I. 
SURGICAL    PATHOLOGY   AND    PRACTICE. 


L— DENTIGEROUS    CYSTS    IN    THE  TEMPORAL   REGION. 

A  FEW  days  ago  our  advice  was  sought  concerning  a  horse  which 
showed  on  the  temporal  region,  a  little  in  front  of  and  above  the  eye,  a 
soft,  fluctuating,  indolent  swelling,  which  several  of  you  thought  to  be  a 
simple  cyst,  and  others  took  for  a  "  cold  abscess."  The  owner  of  the 
horse  having  been  offered  several  contradictory  opinions  as  to  the 
nature  of  this  swelling,  and  the  proper  method  of  treatment,  had 
hnally  decided  to  send  the  animal  here. 

On  account  of  the  position  and  character  of  the  swelling,  I  at  once 
came  to  regard  it  as  a  dental  or  dentigerous  cyst  developed  in  the 
temporal  region,  an  abnormality  of  which  you  will  probably  not  see 
another  example  during  the  course  of  the  present  year.  I  was  therefore 
anxious  to  utilise  the  chance  offered  of  drawing  your  attention  to  this 
singular  condition,  the  nature  of  which  has  long  been  known,  but  which 
often  escapes  notice,  although  a  number  of  cases  have  been  described. 

Dentigerous  cysts  have  been  found  in  many  species  of  animals  and 
in  various  organs,  particularly  in  the  genital  region,  in  the  ovary  and 
testicle.  They  are,  however,  specially  common  in  the  temporal  region, 
at  the  base  of  the  ear,  on  the  forehead,  and  in  the  sinuses.  These 
cysts  have  been  divided  into  dental  and  radiculo-dental :  in  the  latter, 
which  are  rare,  the  root  of  the  tooth  projects  towards  the  centre  of 
the  cyst ;  whilst  in  the  former,  which  are  more  frequent,  the  crown 

A 


2  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

occupies  that  position.  It  is  of  little  importance  whether  the  tooth  be 
temporary  or  permanent.  The  mere  inclusion  of  a  tooth  will  not 
produce  a  dental  cyst.  In  point  of  fact,  one  sometimes  finds  unde- 
veloped teeth  buried  in  foreign  tissues,  and  cysts  have  been  observed 
in  which  the  included  tooth  does  not  project  into  the  interior  of  the 
cyst  at  all,  but  is  enclosed  in  its  wall. 

Various  theories  have  been  advanced  to  explain  the  pathology 
of  these  cysts.  The  most  probable  is  that  of  Monsieur  Malassez, 
enunciated  during  his  study  of  the  paradental  epithelial  debris.  This 
author  explains  their  origin  by  the  persistence  of  some  epithelial 
debris  around  the  included  tooth,  and  considers  them  due  to  the 
irritation  produced  during  the  growth  of  the  tooth.  Those  containing 
several  teeth  result  from  the  formation  of  a  cyst  at  some  spot  where 
several  tooth  germs  have  been  buried  close  together  ;  the  teeth  deve- 
lop and  break  into  the  cyst  cavity. 

I  leave  on  one  side  the  general  history  and  pathology  of  these  curious 
growths ;  I  wish  to  speak  particularly  from  the  clinical  standpoint, 
and  to  restrict  myself  to  dentigerous  cysts  of  the  temporo-auricular 
region,  which  are  by  far  the  commonest  and  most  interesting  to  the 
practitioner.  Their  degree  of  frequence  is  established  by  statistics 
long  ago  published  by  Lanzilotti  and  Generali.  Of  seventy-five  cases 
mentioned  in  the  veterinary  journals  sixty-eight  were  of  this  character. 

I  believe  Mage-Grouille  published  the  first  authentic  case  in  De 
Fromage  de  Feugre's  Corrcspondancc.  He  punctured  a  collection 
of  fluid  developed  between  the  left  zygomatic  process  and  ear  of  a 
three-year-old  colt.  At  the  base  of  the  cavity  he  found  implanted  in 
the  cranial  wall  a  sort  of  "  bony  peg,"  which  he  removed.  It  was  a 
large,  irregular  molar,  measuring  two  and  three  eighths  inches  in 
length,  and  three  and  a  half  in  circumference. 

Under  the  title  of  '  Eburnated  Degeneration  of  the  bony  part  of  the 
Temporal,'  Rodet  related  in  1827  a  second  case  of  supernumerary  teeth. 

The  following  year  Benard  recorded  a  third  case  in  the  Rccueil, 
and  corrected  Rodet's  diagnosis.  You  will  find  in  one  of  Goubaux's 
Reports,  communicated  to  the  Central  Society  of  Veterinary  Medi- 
cine in  1853,  an  outline  of  the  principal  cases  published  at  that  date. 
Among  the  more  recent  works  relative  to  this  question  I  may  cite  an 
article  of  Macorps,  inserted  in  the  Annals  of  'Veterinary  Medicine  of 
i860,  and  the  memoir  of  Lanzilotti  and  Generali,  published  in  1873  in 
the  Ga::zetta  Vcterinaria. 

Our  last  case  may  be  described  in  a  few  words.  The  animal  is  a 
four-year-old  horse,  bought  at  Beauce  a  fortnight  ago  by  a  dealer,  who 


DENTIGEROUS    CYSTS    IN    THE    TEMPORAL    REGION.  3 

did  not  notice  the  existence  of  the  svveUing.  One  morning,  however, 
he  remarked  on  the  left  side  of  the  animal's  head  a  swelling  the  size 
of  a  small  egg.  Being  unable  to  obtain  any  exact  information  as  to 
its  nature  and  gravity  he  sent  the  horse  here.  At  the  first  examina- 
tion it  was  easy  to  see  that  we  had  not  to  deal  with  an  abscess.  The 
swelling  was  uniformly  soft,  fluctuating,  cold,  and  painless.  Its  posi- 
tion in  front  of  the  ear  and  above  the  zygomatic  process,  its  sharp 
dehmitation,  the  absence  of  inflammatory  symptoms,  and  the  dis- 
covery of  a  prominence  of  bony  consistence  in  the  depths,  sufficiently 
suggested  its  nature.  It  was,  in  fact,  a  dentigerous  cyst.  The  owner 
did  not  wish  to  run  the  risks  of  treatment,  and  removed  the  horse. 

In  October  last  I  operated  on  a  two-year-old  colt,  which  showed 
an  open  sinus  about  three  eighths  of  an  inch  in  front  of  the  base  of 
the  ear.  This  sinus,  which  ran  obliquely  forwards  and  was  about 
four  inches  long,  ended  over  a  kind  of  rough  bony  swelling,  which 
was  regarded  by  some  of  you  as  an  exostosis,  by  others  as  a  necrotic 
patch  of  bone.  The  animal  having  been  cast,  and  the  front  of  the 
fistula  laid  open,  we  discovered  a  rounded  prominence  of  bony  con- 
sistence, with  an  irregular  summit  and  smooth  sides.  It  was,  in  fact, 
a  supernumerary  tooth.  I  seized  it  with  dental  forceps  and  attempted 
to  loosen  it.  It  readily  became  detached,  and  when  extracted  had  the 
appearance  of  a  small  molar.  A  little  behind  was  another,  which 
I  removed  without  much  difficulty.  The  cavities  left  by  these  teeth 
were  rounded,  regular,  and  partly  lined  with  fibrous  membrane. 
Haemorrhage  was  trifling.  The  cavities  were  curetted  and  plugged 
with  gauze.  The  dressing  was  renewed  in  forty-eight  hours  and 
several  times  later.     In  a  month  the  wound  had  healed. 

In  1888  I  saw  another  case  of  this  kind,  in  which  intervention  was 
equally  simple  and  cure  rapid.  Towards  the  middle  of  September  a 
six-year-old  horse  was  sent  to  the  external  Clinique,  with  an  old 
sinus  in  front  of  the  ear.  The  margins  were  denuded  of  hair, 
hardened,  and  from  them  escaped  a  little  greyish,  laudable  pus,  with- 
out offensive  odour.  A  probe  introduced  into  this  sinus  was  finally 
stopped  by  a  raw,  bony  surface,  and  by  manipulating  it  a  little  I  was 
able  to  satisfy  myself  of  the  presence  of  some  hard  moveable  body, 
like  a  sequestrum.  Having  opened  up  the  fistula,  I  removed  this 
body  with  a  pair  of  bent-necked  forceps.  It  proved  to  be  a  small 
molar,  completely  detached,  and  held  in  its  alveolus  by  a  root  little 
larger  than  the  crown.  The  walls  of  the  cavity  were  scraped,  and 
the  parts  washed  out  with  strong  carbolic  solution.  Suppuration 
proceeded  for  several  weeks,  doubtless  because  of  some  change  in  the 
bone,  but  the  wound  eventually  healed. 


4  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

Dentigerous  cysts  in  the  temporal  region  usually  appear  during  the 
first  few  years  of  life — in  fact,  during  the  period  of  dentition.  At  first 
the  dentigerous  cyst  consists  of  a  soft  swelling,  flattened  or  hemi- 
spherical, painless,  or  slightly  sensitive,  varying  in  size  between  that 
of  a  nut  and  an  egg.  Sometimes  it  persists  for  long  in  this  condition  ; 
in  other  cases — and  this  is  the  more  common — the  skin  ulcerates 
towards  the  centre,  or  at  some  point  of  its  surface,  the  contents  of  the 
cyst  escape,  and  a  sinus  forms. 

As  a  rule,  the  opening  of  the  sinus  is  at  the  side  of  the  cranium,  a 
little  in  front  of  and  an  inch  or  so  from  the  base  of  the  ear, — occasion- 
ally, however,  on  a  level  with  the  scutiform  cartilage  ;  sometimes  it  is  a 


Fig.  I. — Pre-auricular  fistula  due  to  presence  of  a  dentigerous  cyst. 


little  further  forward,  sometimes  nearer  the  middle  line  or  the  zygo- 
matic process  ;  occasionally  it  is  situated  at  the  base  of,  or  more  or 
less  high  upon,  the  free  portion  of  the  ear.  In  Rodet's  and  several 
other  cases  the  sinus,  though  opening  some  distance  up  on  the 
conchal  cartilage,  had  originated  from  near  the  zygomatic  process. 
The  wound  is  sometimes  encircled  with  a  ring  of  granulation,  some- 
times appears  as  a  simple  aperture  in  the  skin,  but  more  frequently  is 
situated  at  the  base  of  a  narrow  infundibulum,  produced  by  the  retrac- 
tion of  the  walls  of  the  fistula.  In  most  cases  the  parts  are  swollen, 
or  indurated  to  a  greater  or  less  extent,  but  when  the  condition  is  old- 
standing,,  the  swelling  or  induration  which  at  first  existed  may  almost 
have  disappeared. 


DENTIGEROUS    CYSTS    IN    THE    TEMPORAL    REGION.  5 

The  sinuses  vary  in  extent,  some  being  only  three  quarters  to  an 
inch  and  a  half,  others  three  or  four  inches  deep.  A  probe,  when 
introduced,  comes  in  contact  with  a  rough,  irregular,  bony  surface, 
which  gives  a  sensation  similar  to  that  produced  by  a  fragment  of 
necrosed  bone  still  adherent  to  the  surrounding  parts.  Sometimes 
one  can  distinguish  an  irregular  protuberance,  surrounded  by  a  trifling 
circular  depression.  In  other  cases,  like  that  to  which  I  have  just 
drawn  your  attention,  the  body  encountered  is  moveable.  What- 
ever its  position  and  characters,  the  sinus  always  discharges  a  thin 
greyish  pus,  more  or  less  abundant,  inodorous  or  foetid,  which  glues 
together  the  neighbouring  hair,  and  sometimes  forms  on  the  cheek  or 
parotid  region  a  long  streak,  in  which  greyish  particles  may  be 
detected. 

A  sinus  of  this  nature  being  formed,  the  condition  may  persist  for 
years  without  much  change  ;  the  amount  of  suppuration  varying  from 
time  to  time.  In  some  animals  the  discharge  almost  ceases  at  certain 
periods,  and  the  sinus,  becoming  reduced  to  very  trifling  dimensions, 
seems  to  heal.  Later  the  parts  become  inflamed,  suppuration  in- 
creases, and  the  flstula  reopens,  or  another  appears  in  the  neighbour- 
hood. In  old-standing  cases  several  cicatrices,  due  to  closed  sinuses, 
may  often  be  detected  around  the  wound. 

Besides  the  recorded  cases  of  multiple  supernumerary  teeth,  others 
exist  where  several  dental  cysts  have  developed  in  succession,  each 
giving  rise  to  a  fistula. 

In  Rodet's  case,  after  the  extraction  of  the  first  tooth  a  second  cyst 
appeared.  The  fourteenth  case  treated  by  Macorps  was  operated  on 
twice  at  an  interval  of  three  months.  Each  time  a  tooth  was 
removed.  A  little  later  a  new  fluctuating  swelling  appeared,  due  to 
the  eruption  of  a  third  tooth.  Such  relapses,  however,  have  only  been 
recorded  in  a  few  instances. 

As  a  rule  these  cysts  neither  produce  functional  disturbance  nor 
general  symptoms,  though  exceptions  to  this  rule  exist.  Two  patients 
treated  by  Macorps  and  Gamgee  showed  difficulty  in  mastication 
and  general  wasting,  troubles  which  only  disappeared  after  removal 
of  the  tooth.  Much  graver  complications  may  occur  when  the  tooth 
develops  within  the  cranial  cavity,  thrusts  back  the  dura  mater,  and 
compresses  the  brain.  Bay  has  related  an  interesting  case  of  this 
ciiaracter.  A  horse  which  had  long  suffered  from  a  non-fistulous 
swelling  of  the  temporal  region,  but  without  accompanying  disturb- 
ance, died  in  twenty-four  hours  with  symptoms  of  meningitis  and 
encephalitis.  Autopsy  revealed  the  presence  within  the  cranium  of 
a  new  growth  of  apparently  osseous  nature,  which,  on  more  careful 


0  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

examination,  was  found  to  consist  of  four  molar  teeth ;  the  two  lower 
had  developed  from  the  region  of  the  sella  turcica,  and  compressed 
portions  of  the  brain,  which  in  this  situation,  as  is  known,  is  very 
intolerant  of  injury.  Monsieur  Barreau  published  the  history  of  a 
horse  which,  after  long  suffering  from  a  temporal  sinus,  showed 
difficulty  in  mastication,  general  wasting,  and  unmistakable  signs  of 
some  brain  lesion.  It  was  slaughtered.  In  the  cranium  was  found  a 
kind  of  bony  new  formation,  hemispherical  in  shape,  developed  from 
the  squamous  temporal  bone  and  the  corresponding  wing  of  the 
sphenoid. 

The  anatomico-pathological  characters  presented  by  even  the 
more  benign  of  these  lesions  vary  greatly.  They  may  resemble 
dermoid  cysts,  abscesses,  or  recent  or  old-standing  fistulae.  The  cyst 
generally  contains  only  one  tooth.  Sometimes,  however,  there  may  be 
two,  three,  or  more,  either  distinct  or  fused  together.  They  usually 
present  the  appearance  and  characters  of  molars  ;  in  other  cases  they 
more  closely  resemble  incisors.  Their  shape  is  either  prismatic, 
pyramidal,  or  rounded  ;  the  majority,  however,  are  very  irregular.  In 
composition  they  do  not  essentially  differ  from  normal  teeth,  dentine, 
enamel,  and  cement  being  associated  in  varying  proportions,  the 
dentine  usually  predominating. 

The  firmness  with  which  these  teeth  are  fixed  in  position  varies 
greatly.  In  certain  cases,  as  in  that  seen  by  you,  extraction  is 
easy.  In  others  it  is  difficult,  and  not  without  danger.  In  a  two-year 
colt  Degive,  after  removing  one  tooth,  discovered  a  more  deeply 
placed  eburnated  swelling,  formed  by  several  teeth  incompletely  fused 
together.  The  removal  of  this  growth  opened  the  cranial  cavity,  its 
lower  portion  being  in  direct  contact  with  the  dura  mater. 

Provided  the  nature  of  these  cysts  and  sinuses  in  the  temporo- 
auricular  region  is  recognised,  the  operator  is  less  likely  to  commit 
indiscretions.  Without  doubt,  in  this  as  in  other  regions,  ordinary 
cystic  swellings  develop  sinuses,  and  are  kept  discharging  by  the 
presence  of  bony  or  cartilaginous  necrosis ;  but  such  accidents  are 
infinitely  rarer  than  those  consequent  on  dental  irregularities. 

Several  cases  described  as  necrosis  of  the  scutiform  cartilage — 
Martin's  among  others — and  some  referred  by  the  writers  to  in- 
flammatory changes  of  the  temporal  bone,  can  now  safely  be  assigned 
to  the  presence  of  supernumerary  teeth.  If,  before  intervention,  one 
hesitates  between  diagnosing  a  dental  cyst  or  necrosis  of  bone,  it 
should  be  borne  in  mind  that  the  former  hypothesis  is  by  far  the  more 
probable.     When  the  swelling  embraces  the  base,  and  extends  more 


DENTIGEROUS    CYSTS    IN    THE    TEMPORAL    REGION.  7 

or  less  high  on  the  free  portion  of  the  ear,  it  awakens  suspicion  of 
necrosis  of  the  conchal  cartilage,  and  may  be  mistaken  for  that  at  the 
first  glance,  but  palpation  of  the  parts  and  exploration  of  the  sinus 
generally  settle  the  question. 

What  is  the  prognosis  in  these  lesions  ?  I  have  already  said  they 
persist  for  long  periods,  even  for  years,  I  will  add  that  they  are  very 
rebellious  to  ordinary  treatment.  The  lesion,  whether  only  a  swell- 
ing or  a  sinus,  depreciates  the  value  of  the  animal.  When  there  is 
discharge  of  pus  this  fouls  the  region  of  the  wound,  and  the  parts 
often  emit  a  foetid  odour,  noticeable  on  first  entering  the  stable.  You 
have  seen  that  complications  sometimes  result.  Finally,  if  interven- 
tion is  usually  followed  by  success,  it  may  also  involve  accidents  of  the 
most  serious  character. 

The  treatment  formerly  recommended  included  puncture  of  the 
cyst  or  slitting  up  the  fistula,  and  caustic  injections  or  cauterisation 
of  the  walls  of  the  cyst.  These  methods  are  insufficient.  Cure  can 
only  be  effected  by  removing  the  tooth  and  destroying  the  wall  of  the 
cyst. 

As  a  rule  the  operation  is  simple  and  without  danger.  The  horse 
being  cast,  the  bridle  is  removed  and  the  head  extended.  The  parts 
having  been  prepared,  the  fistula  is  laid  open  or  the  swelling  incised 
in  the  form  of  a  cross,  and  the  tooth  exposed  b}-  reflecting  the  flaps. 
The  attachment  is  often  slight,  or  the  tooth  may  be  loose.  It  is 
easily  removed  with  strong  forceps  or  with  special  tooth  forceps,  the 
cyst  being  afterwards  curetted.  When  it  is  deeply  seated,  and  the 
operator  is  unable  to  grasp  the  crown,  it  may  be  loosened  by  means 
of  a  chisel  and  mallet,  but  cases  occur  where,  in  order  to  free  it,  a 
groove  must  be  formed  around  the  tooth  by  means  of  a  narrow-bladed 
gouge.  It  is  always  necessary  to  proceed  cautiously,  avoiding  vio- 
lence, on  account  of  the  risk  of  fracturing  the  skull  and  injuring  the 
meninges  and  brain.  All  possible  antiseptic  precautions  should  be 
observed.  Even  when  properly  carried  out  the  operation  may  be 
followed  by  various  complications,  by  necrosis  of  a  portion  of  the 
alveolar  wall,  bruised  during  extraction,  by  fracture  of  the  tympanum 
(if  the  tooth  abuts  on  the  middle  ear),  or,  if  the  deep  portion  is  in 
contact  with  the  dura  mater,  by  meningo-encephalitis. 

When  intervention  is  considered  dangerous,  it  is  better  to  refrain 
altogether  from  interfering  with  the  tooth,  rather  than  risk  a  fatal 
accident.  The  only  case  in  which  a  cranial  tooth  should  be  touched 
is  when  it  produces  grave  symptoms  in  consequence  of  its  pressing  on 
the  brain. 


II.— PURULENT    COLLECTIONS    IN    THE    FACIAL 
SINUSES    AND    DENTAL    CARIES. 

During  the  years  i8g6  and  1897  eighteen  horses  affected  with 
collections  of  pus  in  the  sinuses  were  trephined  in  the  hospital. 
According  to  the  nature  or  cause  of  the  disease,  these  eighteen  cases 
may  be  divided  as  follows  : — Simple  inflammation  of  the  sinuses, 
four ;  inflammation  of  the  sinuses  produced  by  tumours,  five ;  inflam- 
mation of  the  sinuses  of  dental  origin,  nine. 

The  small  number  of  cases  of  simple  inflammation  is  truly  striking. 
This  may  possibly  be  due  in  part  to  the  fact  that  the  animals  sent  to 
us  are  those  regarded  by  ordinary  practitioners  as  unpromising,  but  I 
believe  the  number  of  cases  of  secondary  inflammation  of  the  sinuses 
is  in  reality  greater  than  is  generally  supposed.  In  addition  to  dental 
caries  and  to  true  tumours  one  sees  diffuse  myxomatous  degeneration 
of  the  mucous  membrane  of  the  sinuses. 

In  all  the  cases  of  inflammation  of  the  sinuses  due  to  new  growths 
the  tumours  were  malignant  or  beyond  operation.  I  therefore  confined 
myself  to  trephining  and  verifying  diagnosis. 

In  the  cases  of  dental  origin,  treatment  consisted  in  trephining 
the  maxillary  and  frontal  sinuses,  afterwards  enlarging  the  lower  ori- 
fice and  removing  the  diseased  molars  by  punching.  After  cleansing 
the  parts  I  plugged  the  alveolar  cavity  with  gauze  and  cotton  wool ; 
this  dressing  was  renewed  every  twenty-four  or  forty-eight  hours ;  the 
sinuses  were  cleansed  and  irrigated  as  in  cases  of  simple  collections  of 
pus.  The  results  have  been  good.  Of  nine  horses  thus  treated  six 
were  cured  in  a  month  to  six  weeks. 

The  alveolar  cavity  does  not  heal  with  equal  readiness  in  all  cases. 
In  some  it  fills  up  slowly,  in  others  with  fair  rapidity,  and  these 
differences  are  seen  in  animals  of  the  same  age  or  thereabouts.  In  the 
following  case  closure  of  the  cavity  was  particularly  rapid. 

In  November,  i8g6,  I  had  to  punch  out  the  third  and  fourth  upper 
molars  of  a  seven-year-old  mare.  The  large  communicating  space 
between  the  mouth  and  sinus  was  plugged  with  gauze  and  wadding. 


PURULENT    COLLECTIONS    IN    THE    FACIAL    SINUSES    AND    DENTAL    CARIES.  Q 

the  dressing  being  renewed  daily  for  the  first  week,  and  every  second 
day  for  the  next  three  weeks.  At  the  end  of  this  time  the  alveolar 
cavity  of  the  third  molar  was  almost  filled  up.  That  of  the  fourth  still 
admitted  a  man's  little  finger.     Ten  days  later  only  a  narrow  canal 


Fig.  2. — Shows  the  method  of  closing  the  communicating  orifice  between  the 
mouth  and  maxillary  sinus  left  after  punching  out  a  molar  tooth. 


existed,  food  no  longer  passed  into  the  sinus,  and  the  mare  was  able 
to  leave  the  hospital.  Towards  the  end  of  January  we  were  informed 
that  cure  was  perfect. 

At  the  commencement  of  June  of  the  same  year,  one  of  my 
colleagues  in  the  Seine  and  IMarne  district  sent  me  a  horse  affected 
with  double-sided  collections  of  pus  of  dental  origin.  On  the  right  side 
the  condition  was  due  to  caries  of  the  third  molar,  and  on  the  left  to 
caries  of  the  fourth.  We  first  trephined  the  right  side  and  punched 
out  the  diseased  molar.  In  five  weeks,  with  the  precautions  just 
mentioned,  the  alveolar  cavity  had  filled  up.  We  then  performed  the 
same  operation  on  the  left  side.  The  parts  healed  as  steadily  as 
before,  although  the  alveolus  closed  rather  more  slowly,  and  healing 


lO  CLINICAL    VETERINARY    MEDICINE    AND    SUROERV. 

was  not  complete  until  the  eighth  week.  The  pain  and  disturbance  of 
mastication  caused  by  the  caries  and  by  the  two  operations  had 
produced  very  marked  bodily  wasting,  but  the  diseased  animal  gradually 
improved.  A  fortnight  later,  after  the  second  operation,  its  weight  was 
642  kilogrammes,  a  fortnight  later  it  weighed  649  kilos.,  and  in  a 
month  660  kilos.* 

Another  horse,  in  which  I  punched  out  the  fourth  left  molar,  quitted 
the  infirmary  when  the  opening  between  the  mouth  and  sinus  was  still 
of  considerable  size.  It  was  neglected,  food  accumulated  in  the  sinus, 
and  the  discharge  again  became  abundant  and  horribly  foetid.  At  the 
end  of  two  months  it  was  returned  here  in  an  extremely  thin  condition. 
The  sinuses  were  full  of  stinking  food  material  and  pus.  The  walls  of 
the  alveolar  cavity  were  lined  with  a  whitish,  fibrous,  pseudo-mucous 
membrane,  which  gave  no  hope  of  satisfactory  granulation.  I  decided 
to  fill  the  parts  with  gutta  percha.  The  animal  was  cast  on  Daviau's 
table,  the  mouth  kept  open  with  a  gag,  and  the  tongue  moderately 
drawn  to  the  right  side,  so  as  to  freely  expose  the  left  molars.  The 
sinus  and  alveolar  cavity  were  carefully  cleansed  and  dried  with 
tampons  of  cotton  wool.  Two  pieces  of  gutta  percha,  softened  in 
water  at  about  112°  F.,  were  pushed  from  the  sinus  into  the  alveolus, 
and  fixed  with  the  aid  of  the  left  index  finger  introduced  into  the  sinus, 
the  right  being  introduced  by  the  mouth  between  the  third  and  fifth 
molars.  I  was  careful  to  slightly  flatten  out  the  upper  part  of  the 
inserted  piece  on  the  wall  of  the  sinus  around  the  alveolar  orifice,  and 
the  lower  part  around  the  two  neighbouring  molars.  In  order  to  more 
rapidly  harden  the  gutta  percha  it  was  irrigated  for  some  minutes  with 
cold  water  both  by  the  mouth  and  by  the  sinus.  The  latter  was  after- 
wards plugged  with  gauze.  The  dressing  was  renewed  each  following 
day.  A  discharge  occurred  around  the  upper  part  of  the  mass  of 
gutta  percha,  but  was  trifling  in  quantity  and  no  longer  foetid.  The 
trephined  orifice  was  left  open  and  contracted  little  by  little.  The 
animal's  condition  gradually  improved.  When  it  left  the  school  a 
week  later  it  only  showed  a  trifling  discharge,  and  the  trephine  wound 
scarcely  suppurated. 

This  animal  was  brought  back  again  in  six  months.  It  fed  well, 
and  its  condition  had  become  excellent.  A  trifling  quantity  of  muco- 
purulent discharge  escaped  from  the  left  nostril,  but  there  was  no 
offensive  odour.  The  trephine  wound  had  become  replaced  b}-  a 
narrow  fistula,  which  discharged  a  little  whitish  pus  without  odour. 
Examined  through  the  mouth,  the  piece  of  gutta  percha  was  not  in 
any  way  displaced,  and  continued  to  perform  its  function  perfectly. 

*  A  kilogramme  =  2"2  lbs.  English. 


PURULENT    COLLECTIONS    IN    THE    FACIAL    SINUSES    AND    DENTAL    CARIES.        II 

Altogether  the  operation  has  given  very  good  results,  for  before  the 
alveolus  was  closed  the  sinus  was  continually  full  of  decomposing  food 
material,  etc.,  and  the  smell  was  repulsive. 

In  the  three  cases  of  simple  inflammation  of  the  sinus  cure  was 
readily  effected ;  in  two  in  less  than  a  month,  in  the  other  during  the 
fifth  week. 

In  one  of  these  cases  pus  had  existed  in  the  sinus  for  four  months. 
The  animal,  an  eight-year-old  entire  horse,  had  a  running  from  the  left 
nostril.  The  discharge  was  little  when  at  rest,  but  became  abundant 
during  exercise,  was  whitish,  grumous,  and  offensive.  There  was  no 
trace  of  any  mechanical  injury,  and  no  deformity  or  tenderness  about 


Fig.  3. — The  same  case  as  Fig.  2.     Lower  (palatine)  surface. 


the  region  of  the  sinus.  The  contents  of  the  mouth  had  no  unpleasant 
odour,  and  there  was  no  dental  disease.  The  submaxillary  gland  was 
as  large  as  a  nut,  superficial,  soft,  moveable,  and  indolent. 

The  horse  being  cast,  I  trephined  the  left  inferior  maxillary  sinus, 
giving  exit  to  a  large  quantity  of  yellowish-white,  very  foetid  pus. 
The  cavity  having  been  cleansed,  I  freely  broke  down  the  septum 
between  the  two  maxillary  sinuses,  and  then,  by  means  of  a  centre-bit, 
formed  a  counter-opening  into  the  nostril  from  the  lowest  point  in  the 
inferior  maxillary  sinus.  Night  and  morning  the  patient  was  dressed 
according  to  our  usual  method,  by  washing  out  the  sinuses  with  a  warm 


12  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY, 

antiseptic  solution  and  plugging  the  trephine  opening.  At  the  end  of 
a  week  the  discharge  by  the  trephine  wound  and  left  nostril  had 
already  diminished,  and  afterwards  continued  gradually  to  lessen. 
During  the  fourth  week  we  ceased  plugging  the  wound.  Some  days 
later  the  animal  returned  home. 

As  a  rule,  the  troublesome  cases  are  those  where  the  mucous  mem- 
brane is  thickened,  shows  exuberant  granulations,  or  is  affected  with 
polypoid  degeneration.  Sometimes  persistence  of  the  discharge  is  due 
to  the  anatomical  formation  of  the  inferior  maxillary  sinus,  to  the  fact 
of  its  being  prolonged  an  inch  or  so  below  the  extremity  of  the 
zygomatic  ridge, — that  is,  beyond  the  point  where  this  sinus  is  usually 
trephined  ;  a  quantity  of  pus  remains  in  the  lower  part  of  the  cavity, 
and  keeps  up  inflammation  of  the  mucous  membrane.  It  also  hap- 
pens at  times  that  this  sinus  is  very  large  and  deep,  allowing  the  puru- 
lent fluid  to  accumulate  and  keep  up  exudation  from  the  mucous 
membrane.  In  cases  of  this  nature  it  is  advantageous  to  make  an 
opening  through  the  internal  wall  of  the  sinus,  level  with  the  inferior 
meatus  of  the  nasal  cavity  as  above  indicated.  With  a  small  surgical 
stock  and  bit  the  operation  is  easy.  Care  is  required,  however,  to 
make  the  opening  level  with  the  meatus,  and  not  with  the  internal 
portion  of  the  large  submaxillary  sinus ;  if  placed  too  low  the  instru- 
ment penetrates  into  the  palatine  plate  of  the  superior  maxilla. 

The  need  for  plugging  the  trephine  openings,  to  prevent  their 
closing  up  before  suppuration  ceases,  is  unfavourable  to  cure,  because 
during  the  interval  between  the  times  of  changing  the  dressing  pus  is 
retained  in  the  sinus.  This  may  be  prevented  by  fixing  in  the  openings 
closely  fitting  tubes  of  wood,  provided  with  a  little  handle  on  the 
external  surface.  With  the  same  object,  metal  or  gutta-percha  cannulse 
may  be  employed. 

Before  concluding,  I  must  refer  to  one  of  our  patients  which 
died.  An  entire  cart-horse,  twelve  years  old,  was  brought  here 
towards  the  middle  of  March,  i8g6.  He  had  long  had  a  discharge 
from  the  right  nostril,  which  finally  became  so  offensive  that  the 
driver  refused  to  take  him  out.  The  animal  was  in  a  bad  state, 
thin  and  exhausted  ;  he  lay  down  as  soon  as  he  entered  his  box.  A 
purulent  offensive  discharge  escaped  from  the  right  nostril.  There 
was  no  deformity  of  the  sinus,  and  the  submaxillary  glands  were  little 
enlarged.  On  examining  the  mouth  it  was  seen  that  the  horse 
"  pouched "  his  food  on  both  sides,  especially  on  the  right.  The 
fourth  right  lower  molar  projected  beyond  the  others  nearly  half  an 
inch.     Having  inserted  a  gag,  we  discovered  that  the  corresponding 


PURULENT    COLLECTIONS    IN    THE    FACIAL    SINUSES    AND    DENTAL    CARIES.        1 3 

upper  molar  was  carious.      The  purulent   inflammation   of  the   sinus 
was,  therefore,  of  dental  origin. 

Treatment  was  as  follows : — The  animal  having  been  suitably 
secured,  I  first  cut  away  the  portion  of  the  fourth  lower  molar  which 
projected  above  the  others.  I  then  made  three  closely  placed  trephine 
openings  in  the  inferior  maxillary  sinus,  and  removed  the  intervening 
portions  of  bony  tissue.  On  introducing  the  finger  into  the  sinus  after 
free  irrigation  the  root  of  the  carious  tooth  was  discovered.  This  was 
punched  out.  The  crown  was  almost  entirety  destroyed,  but  the  root 
was  little  damaged.  The  sinus  and  alveolar  wound  were  then  washed 
out  with  warm  creolin  solution  and  plugged  with  gauze. 

Next  day  and  the  following  days  the  dressing  was  renewed.  The 
horse  only  ate  a  part  of  his  food,  but  as  the  temperature  did  not  rise 
more  than  a  few  tenths  of  a  degree,  T  was  not  alarmed.  As,  however, 
the  faeces  were  scanty  and  coated,  I  prescribed  daily  about  four  ounces 
of  sulphate  of  soda.  On  the  third  day  the  bowels  became  relaxed,  but 
the  appetite  always  remained  poor.  The  day  after,  the  condition  was 
greatly  aggravated.  The  animal  was  exceedingly  depressed  and  did 
not  touch  its  food  ;  there  was  twitching  about  the  stifle  and  elbow ;  the 
respiration  was  accelerated,  the  pulse  frequent,  small  and  hardly  per- 
ceptible;  the  conjunctiva  was  slightly  injected:  percussion  and  auscul- 
tation of  the  chest  revealed  nothing  abnormal  ;  there  was  fever  to  the 
extent  of  about  2w°  F.  On  rectal  exploration  the  bladder  was  found 
empty.  In  the  depths  of  the  abdomen  towards  the  right  side  could  be 
felt  a  large,  hard,  slightly  doughy  mass,  which  yielded  under  pressure 
of  the  fingers.  Palpation  of  the  right  flank  appeared  to  indicate  that 
this  hard  mass  was  formed  by  the  cacum  crammed  with  food.  We 
attempted  to  overcome  the  obstruction  by  repeated  enemas,  and  by 
subcutaneous  injection  of  a  mixture  of  pilocarpin  and  eserin.  A  little 
dung  was  passed.  During  the  day  the  animal  took  a  small  quantity 
of  milk,  but  steadily  became  worse,  and  death  occurred  on  the  following 
day,  preceded  by  symptoms  of  acute  abdominal  pain.  At  the  post- 
mortem examination  food  material  was  found  distributed  in  the  peri- 
toneal cavity,  and  the  posterior  part  of  the  base  of  the  caecum  was  seen 
to  be  ruptured.  The  viscus  itself  was  distended  by  an  enormous  mass 
of  hard  material.  The  tear  was  surrounded  by  a  large  hyperaemic  zone, 
and  the  ecchymosis  present  clearly  showed  that  the  lesion  was  aute- 
mortem. 

This  animal  had  long  suffered  from  dental  caries  and  difficulty  in 
mastication.  The  food  material  had  ended  by  becoming  impacted 
within  the  caecum. 

I  have  recalled  the  history  of  this  horse  because  it  points  a  moral. 


J  .  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY, 

When  during  the  treatment  of  inflammation  of  the  sinuses,  consequent 
on  dental  mischief,  the  appetite  falls  off,  and  grave  general  disturbance 
occurs,  one  should  beware  of  referring  all  this  to  the  operative  wound, 
and  remember  that  dental  affections  in  the  horse  and  all  large  animals, 
especially  when  prolonged,  favour  obstruction  of  the  large  intestine, 
and  may  bring  about  impaction  of  the  csecum. 


III.— AFFECTIONS    OF   THE   TURBINATED    BONES    IN 

THE    HORSE. 

A  FEW  days  ago,  in  making  an  examination  of  a  horse  which  had 
died  in  hospital,  we  discovered  it  had  suffered  from  necrosis  of  the 
turbinated  bones.  In  drawing  your  attention  to  this  condition  I  am 
completing  what  I  have  already  referred  to  during  my  surgical  patho- 
logical lectures  on  diseases  of  the  nasal  cavities. 

In  the  horse  the  turbinated  bones  are  subject  to  various  diseased 
conditions,  primary  or  secondary  in  character,  of  which,  up  to  the 
present  time,  only  incomplete  and  confused  descriptions  have  been 
given. 

The  few  clinical  observations  published  concerning  these  con- 
ditions refer  (i)  to  hypertrophy  and  eburnation  of  the  turbinated 
bones  ;  (2)  to  tumour  formation  within  them  ;  (3)  to  mucous  degenera- 
tion ;  and  (4)  to  empyema  of  their  cavities  and  to  necrosis. 

In  certain  horses  chronic  nasal  catarrh  is  followed  by  considerable 
thickening  of  the  pituitary  membrane,  and  hypertrophy  of  both  tur- 
binated bones,  or  only  of  the  anterior.  This  hypertrophy  is  some- 
times general,  but  more  frequently  partial.  The  mucous  membrane 
becomes  hyperplastic,  irritated,  fibrillated,  is  usually  pale  and  firm, 
but  sometimes  reddish  and  less  consistent.  The  anterior  turbinated 
bone,  hypertrophied  and  firm,  forms  a  conical  or  cylindrical  poly- 
pous mass,  which  compresses  neighbouring  parts,  causes  atrophy  of 
the  posterior  turbinated  bone,  and  more  or  less  completely  fills  the 
nasal  cavity  on  the  affected  side.  Sometimes,  as  in  the  case  men- 
tioned by  Stockfleth,  it  becomes  as  hard  as  bone  or  ivory.  It  ma\- 
attain  such  dimensions  as  inwardly  to  displace  the  nasal  septum,  above 
the  nasal  bone,  and  externally  the  wall  of  the  sinuses,  into  which  it 
penetrates.  There  is  always  more  or  less  abundant,  sometimes 
foetid,  muco-purulent  discharge.  The  diminution  in  size  of  the  nasal 
cavity  impedes  respiration,  and  gives  rise  to  an  abnormal  whistling  or 
roaring  sound.  Later  the  upper  portion  of  the  face  becomes  de- 
formed, the  diseased  side  projecting,  in  consequence  of  the  upper  wall 
of  the  nasal  cavity  and  of  the  sinuses  being  pushed  up  from  below. 


1 6  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

Only  in  exceptional  cases  does  the  turbinated  bone  become  hyper- 
trophied  in  its  anterior  part,  so  as  to  become  visible  on  opening  the 
wings  of  the  nostril,  but  the  swelling  can  often  be  felt  with  the  finger  ; 
when,  however,  it  is  limited  to  the  upper  part  of  the  turbinated  bone  it 
can  be  detected  only  by  a  catheter,  or  by  examination  with  the 
rhino-laryngoscope,  and  in  order  to  determine  the  character  of  the 
new  growth  a  portion  of  morbid  tissue  must  be  examined  micro- 
scopically. 

Although  most  cases  of  hypertrophy  of  the  turbinated  bones 
result  from  chronic  inflammation  of  the  nasal  mucous  membrane,  the 
only  surgical  treatment  which  can  be  recommended  and  which  proves 
successful  consists  in  ablation  of  the  diseased  bone. 

The  operation  may  be  performed  in  two  ways.  In  the  first,  the 
bone  is  removed  through  the  nose  with  long  powerful  forceps  or  a 
pointed  hook.  Hoyer,  who  used  a  hook,  was  obliged  to  make  several 
attempts  in  order  to  remove  all  the  diseased  bone.  Bleeding  was 
trifling,  and  the  animal  recovered. 

The  other  operative  method,  recommended  by  Jessen,  consists  in 
freely  trephining  the  roof  of  the  nasal  cavity,  making  a  large  opening 
through  which  the  turbinated  bone  is  removed.  Ablation  can  then 
be  performed  more  methodically  and  completely,  while  if  bleeding  is 
abundant  it  is  more  easily  checked  by  cauterisation  and  plugging. 
Jessen  cured  four  animals  by  this  method,  which  has  succeeded  equally 
well  in  the  hands  of  other  practitioners. 

Whatever  the  technique  employed,  removal  of  the  hypertrophied 
bone  does  not  always  cure.  In  some  cases,  especially  when  of  old 
standing,  fungous  growths  develop  at  the  seat  of  operation,  and  in  a 
short  time  again  obstruct  the  nasal  cavity. 

New  growths  of  varying  character  may  develop  on  the  turbinated 
bones.  In  the  horse  the  commonest  are  mucous  or  fibrous  polypi, 
myxomata,  or  fibromata,  the  evolution  of  which  is  usually  slow.  At 
first  the  symptoms  are  those  of  chronic  catarrh,  with  unilateral  muco- 
purulent discharge,  sometimes  streaked  with  blood.  Later,  respiration 
is  impeded  (as  in  the  preceding  condition),  inspiration  especially 
being  more  or  less  noisy.  The  animal  frequently  snorts,  and  as  the 
tumour  increases  the  symptoms  become  more  marked.  One  meets  with 
polypi  originating  from  the  base  of  one  of  the  turbinated  bones,  or 
from  the  ethmoid  bone  extending  into  the  nasal  cavity,  generally  along 
the  floor,  or  along  the  middle  meatus,  and  pushing  back  the  turbi- 
nated bones,  finally  reaching  almost  to  the  nostrils.  In  other  cases  they 
extend   towards  the   pharynx  and  interfere  with   deglutition ;   others, 


AFFECTIONS    OF    THE    TURBINATED    BONES    IN    THE    HORSE.  1 7 

again,  resemble  the  naso-pharyngeal  polypi  of  man,  and  extend  in  all 
directions,  invading  the  bone,  and  filling  up  the  sinuses.  This  last 
variety,  common  in  the  dog,  is  exceptional  in  the  horse ;  but  a  benign 
polypus,  when  of  large  volume,  may  push  aside  the  nasal  septum  and 
the  turbinals  and  raise  the  nasal  bone,  completely  blocking  the  nasal 
cavity  and  deforming  the  face.  Sarcomata,  which  are  much  rarer 
than  polypi,  extend  to  the  bones  forming  the  nose,  and  usually 
acquire  large  dimensions  in  a  very  short  time.  Epitheliomata  (pave- 
ment, or  cylindric  celled)  are  equally  rare.  They  rapidly  seize  on  the 
lymphatics,  and  produce  metastatic  inflammation  of  the  submaxillary 
gland. 

Treatment  is  limited  to  benign  tumours,  /.  e.  to  polypi.  Several 
cases  of  spontaneous  cure  have  been  related.  The  tumour  has  finally 
been  expelled  during  snorting  or  coughing.  Such  a  termination, 
however,  is  rare,  and  must  not  often  be  looked  for.  Ablation  should 
be  performed  by  the  method  I  shall  describe  in  speaking  of  disease  of 
the  upper  turbinated  bone. 

Under  the  name  of  mucous  degeneration  of  the  turbinated  bones, 
Sand  has  described  in  the  colt  an  affection  of  these  parts,  and  of  the 
bones  of  the  nose  and  face,  the  symptoms  of  which  recall  those  of 
inflammatory  hypertrophy  of  the  turbinated  bones,  and  of  tumours  in 
the  nasal  cavities. 

It  is  marked  by  unilateral  muco-purulent  discharge,  by  diffuse 
swelling  about  the  nose  and  sinuses  on  one  side  of  the  face,  and  by 
abnormal  breathing  sounds,  due  to  partial  obstruction  of  the  nasal 
cavity.  The  swollen  parts  of  the  facial  bones  are  thinned,  parchment- 
like, or  softened,  and  appear  to  fluctuate.  -As  a  general  rule  these 
symptoms  are  first  noted  in  the  region  of  the  maxillary  sinuses,  then 
in  that  of  the  frontal  sinus.  If  a  puncture  be  made  over  the  centre  of 
the  swelling,  and  a  probe  introduced  into  the  sinus,  the  instrument 
passes  in  all  directions  through  a  non-resisting  tissue. 

When  the  condition  is  bilateral,  respiratory  disturbance  maj'  be  so 
severe  as  to  threaten  suffocation  and  necessitate  tracheotomy. 

Sand  lays  stress  on  the  special  anatomical  changes  in  this  affec- 
tion, which  he  states  are  different  from  those  of  inflammatory  hyper- 
trophy of  the  turbinated  bones  and  empyema  of  the  sinuses.  The 
most  striking  points  are  the  dilatation  of  the  sinuses,  and  of  those 
portions  of  the  turbinated  bones  contributing  to  their  formation  ; 
the  destruction  of  the  bony  walls  of  the  sinuses  and  of  the  parchment- 
like leaf  of  the  turbinated  bones,  or,  more  frequently,  the  replacement 
of  a   bony   by  a  mucous    tissue  engorged  with    liquid  ;    finally,  the 

B 


1 8  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

accumulation  of  a  serous  exudate  in  the  sinuses,  whose  orifice  of 
communication  with  the  nasal  cavity  has  disappeared. 

The  cause  of  the  disease  is  obscure.  It  seems  always  to  appear  in 
young  animals.  In  some  cases  it  makes  rapid  progress  ;  in  others,  on 
the  contrary,  it  is  chronic,  develops  very  slowly,  and  only  produces 
functional  disturbance  after  the  lapse  of  years. 

Treatment  is  similar  to  that  of  catarrhal  inflammation  of  the 
mucous  membrane  of  the  sinuses :  trephining,  drainage,  and  anti- 
septic injections.  Sand  states  that  these  methods  usually  suffice  to 
arrest  or  cure  recent  cases. 

Collections  of  pus  in,  and  necrosis  of  the  turbinated  bones,  have 
sometimes  been  regarded  as  due  to  glanders.  A  certain  number  of 
cases,  most  of  them  recent,  have  shown  that  such  complications  may, 
however,  be  purely  local  in  character,  sometimes  consequent  on  acute 
inflammation  of  the  pituitary  membrane,  caries  of  the  last  molars, 
indirect  injury  of  the  turbinated  bones  through  the  bones  of  the  face, 
or  direct  injury  through  the  nostrils. 

On  post-mortem  examination  I  have  never  found  necrosis  of  the 
turbinated  bones  as  a  primary  affection,  and  had  often  debated  with 
myself  whether  published  cases  were  not  complications  of  hyper- 
trophic rhinitis,  or  of  Sand's  disease,  until  last  week  I  saw  the  case  to 
which  I  referred  at  the  commencement  of  this  lecture.  The  facts  are 
as  follows : 

On  the  afternoon  of  the  4th  May  one  of  my  colleagues  *  sent  me 
a  twelve-year-old  mare,  which  had  been  ill  for  a  fortnight.  The 
condition  was  indicated  by  discharge  from  the  nostrils,  and  had  at 
first  been  regarded  as  due  to  a  trifling  sore  throat.  The  discharge 
from  the  right  nostril,  however,  persisted,  and  later  increased  and 
grew  foetid. 

On  the  3rd  May  the  animal's  condition  suddenly  became  aggra- 
vated. The  patient  was  greatly  depressed,  had  difficulty  in  standing, 
and  refused  food.  It  was  sent  to  the  College.  On  arrival  it  could 
only  be  kept  on  its  legs  for  a  short  time  by  partially  lifting  it  with 
wooden  bars,  and  soon  had  to  be  let  down  on  the  straw.  Its  coma- 
tose condition,  the  paralytic  symptoms,  diminution  of  general  sensi- 
bility, and  contraction  of  the  pupil,  indicated  some  affection  of  the 
meninges  and  brain.  On  the  other  hand,  the  foetid  discharge  running 
from  the  right  nostril,  and  trifling  sweUing  of  the  submaxillary  glands, 

*  An  outside  practitioner.  It  is  usual  in  France  for  a  professor  thus  to  refer  to  a  prac- 
titioner, or  for  one  practitioner  to  refer  to  another.  Unfortunately  we  do  not  use  the  term 
quite  in  this  sense,  and  I  cannot  translate  it  more  exactly. — Jno.  A.  W.  D. 


AFFECTIONS    OF    THE    TURBINATED    BONES    IN    THE    HORSE.  19 

aroused  suspicion  of  pus  formation  in  the  sinuses,  or  turbinated  bones- 
The  temperature  was  ioi'i°F.,  the  pulse  60,  and  the  respirations  36 
per  minute.  I  first  explored  the  naso-pharyngeal  cavity  with  a 
catheter,  and  afterwards  trephined  the  nasal  bone.  The  right  nasal 
cavity  was  clear,  not  diminished  in  size,  and  the  sinuses  of  that  side 
contained  no  pus.  I  considered  it  probable  that  the  ethmoid  cells 
were  necrotic,  a  condition  complicated  by  meningo-encephalitis.  I 
prescribed  warm  boric  irrigations  of  the  nasal  cavity,  and  put  off  until 
next  day  examination  with  the  rhino-laryngoscope,  by  which  I  hoped 
to  coniirm  the  diagnosis. 

During  the  night  the  temperature  fell  i*8°F.,the  mucous  mem- 
branes became  reddish-violet,  and  the  coma  was  interrupted  by  an 
attack  of  convulsions  with  spasmodic  contraction  of  the  limbs.  The 
patient  died  next  morning. 

At  the  post-inovteui  examination  we  found  secondary  lesions  of 
purulent  inflammation,  marked  especially  by  the  presence  of  large 
numbers  of  metastatic  pulmonary  abscesses.  The  primary  changes 
were  very  extensive,  affecting  the  turbinated  bones,  ethmoid,  and 
the  antero-inferior  parts  of  the  cranium.  In  the  posterior  portion  of 
the  right  nasal  cavity  the  pituitary  membrane  was  extremely  hyper- 
gemic  and  infiltrated.  Near  its  base  the  maxillary  turbinated  bone 
was  destroyed  over  an  oval  space,  about  an  inch  to  an  inch  and  a 
quarter  in  its  longer  diameter,  which  corresponded  with  the  long  axis 
of  the  nose.  Around  this  point  the  mucous  membrane  was  thickened 
and  blackish,  except  towards  the  back,  where  it  was  covered  with 
necrotic  suppurating  points.  In  front,  the  turbinated  bone  was  full  of 
caseous  putrid  pus.  Opposite  the  lesion  of  the  maxillary  turbinated 
bone,  the  ethmoidal  turbinated  bone  showed  a  necrotic  area  where  the 
mucous  membrane  was  thinned,  greyish-yellow,  and  covered  with 
blood-stained  pus.  The  ethmoid  cells  of  the  right  side  were  deep  red 
in  colour,  and  in  places  ecchymosed  ;  towards  their  base,  the  mucous 
membrane  appeared  partially  necrotic.  The  ethmoid  cells  and  sphe- 
noidal sinus  contained  foetid  pus.  In  the  region  between  the  posterior 
border  of  the  sphenoid,  and  the  superior  border  of  the  cribriform  plate 
of  the  ethmoid,  the  dura  mater  was  thickened,  yellowish  or  greenish- 
grey,  and  everywhere  soaked  in  pus  ;  the  arachnoid  cavity  contained  a 
fibrinous  exudate,  especially  thick  near  the  sella  turcica.  Immersed 
in  pus,  the  pituitary  gland  had  become  softened  and  partly  destroyed. 

Bacteriologically  examined,  pus  collected  from  the  necrotic  portions 
of  the  turbinated  bones  was  found  to  contain  various  micro-organisms, 
but  especially  streptococci,  in  longer  or  shorter  chains — the  greater 
number  in  short  chains — staphylococci,  and  a  small  bacillus  strongly 


20  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

resembling  the  bacillus  of  necrosis  mentioned  by  Bang.  Pus  from  the 
pulmonary  abscesses  also  contained  several  varieties  of  organisms, 
streptococci  predominating.  In  the  intra-cranial  exudate  I  only 
found  streptococci  in  short  chains,  usually  of  three  to  six. 

In  this  patient  the  phases  of  the  process  were  probably  as  follows  : 
At  first,  acute  inflammation  of  the  mucous  membrane  of  the  turbinated 
bones,  and  ethmoid  cells ;  afterwards,  partial  necrosis  of  these  organs, 
and  suppurative  inflammation  of  the  ethmoidal  and  sphenoidal  sinuses. 
From  the  ethmoid  cells,  suppuration  extended  through  the  holes  in 
the  cribriform  plate  of  the  ethmoid  to  the  meninges  of  the  brain. 
While  these  processes  were  gradually  developing  in  the  direction  of 
the  meninges,  pyogenic  organisms  must  have  entered  the  venous 
circulation,  and  brought  about  purulent  infection. 

In  volume  ix  of  the  Jouvnal  of  Military  Veterinary  Medicine, 
Delamotte   recorded  a  case  which  in  regard  to  the    nature   of    its 


Fig.  4. — Necrosis  of  the  turbinated  bones. 


lesions  shows  certain  analogies  to  the  preceding.  It  refers  to  a  mule, 
which  one  morning,  without  any  preliminary  symptoms,  was  suddenly 
attacked  with  abundant  epistaxis,  and  discharged  from  the  mouth 
torrents  of  black,  thick  blood,  of  repulsive  odour.  An  hour  and  a  half 
after  the  onset  of  bleeding  the  animal  died  from  loss  of  blood  and 
asphyxia.  At  the  post-mortem  examination,  in  addition  to  obstruction 
of  the  bronchi  by  blood  and  lesions  of  asphyxia,  the  examiner  found 
the  mucous  membrane  of  the  ethmoid  cells  gangrenous,  greenish- 
yellow,  softened,  and  of  offensive  odour. 

Necrosis  of  the  turbinated  bones  usually  long  remains  localised, 
and  reveals  itself  by  an  offensive,  one-sided  discharge,  interference 
with  respiration   due  to  diminution  in  the  nasal  cavity,  trifling  en- 


AFFECTIONS    OF    THE    TURBINATED    BONES    IN    THE    HORSE.  21 

largement  of  the  submaxillary  glands,  and  swelling  at  the  base  of  the 
forehead.  The  cases  reported  by  Sand,  Moller,  and  Frohner,  all  agree 
in  this  respect.  The  three  cases  referred  to  by  the  latter  are  inter- 
esting from  a  therapeutic  stand-point.  The  essential  facts  are  as 
follows  :  the  first  case  was  that  of  a  six-year-old  mare,  which  showed 
abundant,  yellowish,  offensive  discharge  from  the  right  nostril,  swelling 
of  the  submaxillary  gland,  to  which  the  skin  was  adherent,  injection 
of  the  pituitary  membrane,  and,  towards  the  base  of  the  nasal  bone,  a 
painful  circumscribed  swelling,  over  which  percussion  gave  a  dull  sound. 
The  changes  affected  the  deep  part  of  the  nasal  cavity.  Examination 
by  means  of  the  nasal  mirror  failed  to  explain  the  nature  of  the 
condition.  On  trephining  the  nasal  bone,  the  anterior  turbinated 
bone  was  seen  to  be  partially  necrotic.  The  dead  part  having  been 
removed,  the  cavity  was  washed  out  with  creolin  solution  and  plugged 
with  iodoform  gauze.     Recovery  occurred  in  three  weeks. 

The  second  case  was  that  of  a  twelve-year-old  mare,  showing 
practically  the  same  symptoms  as  the  former.  Discharge,  however, 
was  bilateral,  and  the  swelling  at  the  base  of  the  forehead  was  on  the 
left  side  near  the  wider  portion  of  the  nasal  bone.  This  bone  was 
trephined,  the  diseased  portion  of  the  upper  turbinated  bone  removed, 
and  the  parts  dressed  as  in  the  preceding  case.  Cure  followed  in  a 
fortnight. 

The  third  animal  was  a  nine-year-old  horse,  with  necrosis  of  the 
left  upper  turbinated  bone.  The  same  operation  was  performed 
as  in  the  two  previous  cases.  In  six  weeks  the  animal  was  returned 
home.     Three  weeks  later  it  had  completely  recovered. 

I  ought  to  add  that  in  other  cases  the  result  has  not  been  so  happy. 
Sometimes  the  discharge  has  persisted  much  longer.  In  one  of 
Moller's  cases  necrosis  recurred,  and  recovery  appeared  hopeless. 
You  yourselves  have  seen  that  rapidly  fatal  complications  ma}'  occur. 

The  facts  just  given  and  the  case  I  have  published  sufficiently 
demonstrate  the  occurrence  in  the  horse  of  a  special  disease,  consisting 
in  partial  necrosis  of  one  or  both  turbinated  bones  ;  a  disease  producing 
clinical  signs  permitting  of  diagnosis,  which  sometimes  remains 
localised  for  a  long  period,  sometimes  is  rapidly  followed  by  compli- 
cations, and  which  is  best  treated  by  trephining  the  nasal  cavity, 
removing  necrotic  portions  of  the  turbinated  bone,  and  applying  anti- 
septic dressings. 


IV.— TUMOURS  IN   THE   FACIAL   SINUSES  AND  CANCER 
OF   THE   SUPERIOR   MAXILLA. 

You  recently  saw  in  the  external  clinique  a  patient  with  a  tumour 
of  the  sinuses  and  of  the  bones  of  the  face,  on  which  I  refused  to 
operate.  I  wish  to  explain  to  you  this  morning  the  reasons  for  my 
abstention,  and  for  that  purpose  shall  take  as  my  subject  ''New 
Growths  in  the  Sinuses." 

Although  much  less  frequent  than  catarrhal  inflammations  of  the 
mucous  membrane,  or  simple  inflammation  of  the  sinuses,  new  growths 
in  the  sinus  are,  nevertheless,  not  ver}^  rare.  I  have  collected  a  fair 
number  of  cases,  differing  considerably  from  one  another  in  regard  to 
the  nature  of  the  lesions  and  to  their  gravity. 

In  the  sinuses  of  the  horse  one  meets  with  cysts,  myxomata, 
fibromata,  sarcomata,  and  epitheliomata. 

I  will  shortly  relate  some  clinical  cases,  which  will  give  you  an  idea 
of  the  symptoms,  course,  and  prognosis  of  these  various  tumours,  and 
will  show  you  within  what  limits  intervention  is  permissible. 

Let  us  first  of  all  consider  the  cysts. 

In  1893  a  Percheron  horse,  seven  years  old,  was  sent  to  the  clinique 
on  account  of  a  discharge  from  the  left  nostril  of  two  months'  standing. 
The  discharge  was  thick,  grumous,  and  offensive.  On  the  left  side 
the  submaxillary  gland  was  slightly  enlarged,  and  felt  like  a  little 
bunch  of  grapes,  the  constituent  portions,  however,  being  moveable  one 
over  the  other.  The  external  wall  of  the  sinuses  was  slightly  raised, 
and  sensitive  on  percussion  ;  the  sound  given  was  distinctly  dull.  I 
concluded  that  suppuration  was  occurring  in  the  sinuses.  An  explo- 
ratory puncture  confirmed  the  diagnosis,  and  the  patient  was  left  in 
hospital  for  treatment. 

Having  trephined  the  parts,  we  found  in  the  inferior  maxillary 
sinus,  along  with  a  considerable  quantity  of  pus,  several  small,  soft 
tumours  developed  from  the  mucous  membrane.  In  the  frontal  and 
superior  maxillary  sinuses  the  mucous  membrane  was  simply  thickened 
by    inflammation.       The   teeth    were    normal,    the    maxilla   was    not 


TUMOURS  IN  THE  FACIAL  SINUSES  AND  CANCER  OF  THE  SUPERIOR  MAXILLA.     23 

invaded,  and  the  septum  dividing  the  two  maxillary  sinuses  was  not 
destroyed.  I  incised  one  of  these  tumours  with  the  point  of  a  bistoury, 
and  a  little  viscous  fluid  escaped.  The  case  was  clearly  one  of  cyst 
formation  in  the  mucous  membrane,  without  doubt  at  the  expense  of 
the  small  glands  therein  contained.  I  sufficiently  enlarged  the  opening 
in  the  inferior  maxillary  sinus,  and  scraped  the  mucous  membrane. 
The  head  of  a  thermo-cautery  was  passed  over  the  membrane,  after 
which  the  animal  was  treated  like  a  patient  suffering  from  ordinary 
inflammation  of  the  sinuses,  drainage  being  provided  for,  and  the  parts 
washed  out  twice  daily  with  a  slightly  antiseptic  solution,  followed  by 
astringent  injections.  At  the  end  of  a  month  the  drainage-tube  was 
removed.  The  lower  wound  having  been  plugged  to  prevent  it  closing 
too  rapidly,  allowed  of  our  continuing  the  injections  some  time  longer. 
The  animal  was  returned  to  work  a  few  weeks  afterwards.  Recovery 
was  complete. 

These  mucous  cysts  of  the  sinuses  are  not  common,  at  least  very 
few  cases  have  been  recorded. 

Not  less  rare  are  the  dental  cysts,  of  one  of  which  M.  Liautard 
gives  the  following  interesting  account.  A  seventeen-year-old  mare,  after 
influenza,  discharged  freely  from  the  nose,  showed  slight  swelling  of  the 
submaxillary  gland,  and  a  little  swelling  of  the  right  side  of  the  fore- 
head. An  American  veterinary  surgeon  diagnosed  the  case  as  glanders. 
M.  Liautard,  after  carefully  examining  the  animal,  declared  the  sym- 
ptoms due  to  a  simple  collection  of  pus  in  the  sinuses.  The  teeth 
appeared  sound,  and  there  was  nothing  unusual  in  the  mouth.  On 
opening  the  inferior  maxillary  sinus,  three  dental  cysts  were  found, 
each  containing  a  hard  moveable  body  of  the  consistence  of  enamel, 
— in  fact,  a  rudimentary  tooth  similar  to  those  found  in  cysts  of  the 
temporal  region.  Extraction  of  these  teeth  and  destruction  of  the 
cysts  offered  no  difficulty.     In  some  weeks  recovery  was  complete. 

The  first  division  of  my  subject  comprises  lesions  which  remain 
confined  to  the  sinus,  and  usually  only  reveal  themselves  by  symptoms 
of  suppurative  inflammation  in  these  cavities,  a  condition  which  often 
complicates  tumour  formation  after  the  lapse  of  a  certain  time. 

Myxomata  and  fibrous  polypi  form  two  other  varieties  of  tumours 
of  the  sinus,  commoner  and  graver  than  the  preceding,  save  when  they 
are  recent  and  limited  to  one  of  these  cavities.  Fibrous  polypi,  as  a 
rule,  are  more  dangerous  than  myxomata.  Both  usually  affect  the 
ethmoid  or  the  floor  of  the  sinuses.  They  grow  somewhat  rapidly, 
thrusting  aside  the  bony  walls,  especially  the  external,  invade  neigh- 
bouring parts  of  the  nasal  cavity,  and  may  there  develop  to  a  consider- 


24  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

able  extent,  impeding  respiration  and  producing  a  loud  roaring  sound, 
or  even  death  by  asphyxia.  M.  Trasbot  has  published  a  curious  case 
of  this  nature.  He  had  to  treat  a  mare  which  for  six  months  had 
suffered  from  intermittent  muco-purulent  discharge  from  the  left 
nostril,  sometimes  streaked  with  blood.  Tumour  of  the  sinuses  was 
suspected.  The  discharge  grew  more  and  more  abundant,  the  sub- 
maxillary glands  became  swollen,  and  the  animal  roared  loudly  during 
work.  Further  examination  revealed  nothing,  either  in  the  forward 
portion  of  the  cavities  or  in  the  mouth.  The  roaring  sound  became 
more  intense ;  finally  it  was  produced  when  at  rest  in  the  stable. 
Swallowing  was  interfered  with,  and  the  saliva  escaped  by  the  mouth. 
One  morning  this  animal  was  found  dead  in  its  box.  Post-mortem 
examination  explained  these  peculiar  symptoms.  The  tumour,  which 
arose  from  the  ethmoid,  was  formed  of  two  perfectly  distinct  parts  : 
one  partially  filled  the  frontal  sinus  without  becoming  in  any  way 
adherent  to  its  walls  ;  the  other,  extending  along  the  anterior  turbi- 
nated bone  within  the  nasal  cavity,  had  developed  very  extensively, 
passing  beyond  the  guttural  opening  of  the  nasal  meati,  traversing 
the  pharynx,  and  latterly  arriving  at  the  larynx,  its  extremity  had  at 
last  accidentally  entered  the  latter  and  had  doubtless  excited  spasm, 
followed  by  death.  On  histological  examination  this  tumour  prcved 
to  be  a  myxoma.  Considering  the  narrow  base  from  which  it 
originated  on  the  ethmoid,  excision  would  have  been  easy  had  the 
growth  been  early  discovered. 

M.  Labat  described  a  case  of  polypus  of  the  sinuses,  successfully 
treated  by  ablation,  in  an  eight-year-old  horse.  The  superior  maxillary 
and  frontal  sinuses  of  the  left  side  were  the  seat  of  a  polypoid  tumour, 
which  had  deformed  the  surrounding  hard  tissues.  From  the  bone 
covering  the  superior  maxillary  sinus,  a  triangular  piece,  two  and  three 
quarters  by  three  and  a  half  by  four  inches  in  size,  was  removed.  The 
tumour,  which  was  attached  to  the  roof  of  this  cavity,  was  entirely 
removed.  At  the  end  of  two  months  the  opening  in  the  bone  was 
reduced  to  two  thirds  of  its  former  size,  but  did  not  entirely  fill  up. 
Many  practitioners  have  also  operated  with  success  on  fibromata  and 
myxomata  of  the  sinuses. 

The  cases  I  have  collected  lead  me  to  regard  sarcomata  of  the 
sinuses  as  rather  rare,  nevertheless  cases  are  seen  from  time  to  time. 
A  number  of  you,  without  doubt,  remember  a  horse  whose  case  formed 
the  subject  of  a  clinical  lecture  last  year,  and  the  slaughter  of  which  I 
recommended  on  account  of  sarcoma  of  the  superior  maxillary  bone 
and  of  the  sinuses.     When  brought  here  this  horse  showed,  on  the  left 


TUMOURS  IN  THE  FACIAL  SINUSES  AND  CANCER  OF  THE  SUPERIOR  MAXILLA.     25 

side  of  the  face,  a  hard,  diffuse,  shghtly  painful  tumour,  without 
enlargement  of  the  corresponding  submaxillary  space.  A  purulent 
discharge  escaped  from  the  left  nostril.  On  examining  the  cavity  of 
the  mouth  we  only  noted  a  trifling  swelling  of  the  mucous  membrane 
on  each  side  of  the  line  of  molars.  The  horse  being  old  and  used  was 
slaughtered.  Post-mortem  examination  showed  that  the  sinuses  of  the 
left  side  were  to  a  great  extent  filled  by  this  tumour. 

I  confine  myself  to  merely  mentioning  melanotic  and  mycotic 
tumours,  which  in  exceptional  cases  may  be  met  with  in  the  sinuses. 

I  now  arrive  at  an  extremely  grave  form  of  secondary  tumour 
occurring  in  these  cavities :  I  mean  epithelioma.  The  history  of 
a  few  patients  will  doubtless  fix  in  your  minds  the  symptoms  and 
malignity  of  these  tumours. 

Towards  the  end  of  last  year,  a  ten-year-old  horse  was  brought 
here  by  a  man  who  had  bought  it  a  few  days  before.  He  had  noted 
that  the  cheek  was  swollen,  that  the  animal  had  a  discharge  from  the 
left  nostril,  and  that  it  ate  with  difficulty,  symptoms  which  he  thought 
would  be  cured  by  a  few  applications  of  the  tooth  rasp. 

The  animal's  general  condition  was  good,  though  it  showed  some 
depression,  and  the  face  indicated  suffering.  Attention  was  specially 
arrested  by  a  curdled  stinking  discharge  from  the  nose,  and  by  strings 
of  saliva  running  from  the  mouth.  On  examining  the  cavity  of  the 
mouth,  the  nature  of  the  condition  was  easily  recognised.  Unfor- 
tunately, it  was  not  at  all  what  the  owner  had  thought.  The  buccal 
cavity  contained  a  large  tumour,  involving  the  hard  palate,  and 
extending  the  entire  length  of  the  left  upper  row  of  molars.  It 
projected  slightly  above  the  level  of  the  mucous  membrane,  so  that  its 
anterior  boundary  opposite  the  second  molar  was  clearly  distinguish- 
able. Other  points  were  made  out  by  inserting  a  gag,  and  artificially 
lighting  the  mouth.  The  last  left  molars,  partially  buried  in  exuberant 
granulations  arising  from  the  new  growth,  were  already  loose.  The 
prominence  formed  by  the  tumour  was  only  pronounced  in  the  neigh- 
bourhood of  the  molars ;  over  the  greater  part  of  the  hard  palate  it 
was  scarcely  noticeable.  The  mucous  membrane  appeared  simply  to 
be  covered  by  a  kind  of  granular  membrane.  The  lower  nasal  cavity 
was  deformed,  its  floor  bulged  upwards  owing  to  pressure  exercised  by 
the  tumour.  The  latter  extended  to  the  interior  of  the  maxilla,  but 
had  principally  developed  in  the  mouth  and  sinuses.  Another  impor- 
tant symptom  consisted  in  swelling  of  both  submaxillary  glands,  a 
condition  strongly  indicating  the  nature  of  the  new  growth.  The  sub- 
maxillary gland  on  the  left  side  formed  a  bosselated  very  hard  mass. 


26  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

as  large  as  an  egg,  and  adherent  to  the  deeper-seated  tissues.  The 
right  was  the  size  of  a  pigeon's  egg,  showed  the  same  irregularity, 
and  was  very  hard.  The  diagnosis  of  epithelioma  of  the  maxilla  was 
therefore  fairly  clear.  The  animal  was  incurable.  Being  asked  to 
leave  it  for  a  time,  the  owner  preferred  to  remove  and  re-sell  it,  so 
that  I  did  not  again  see  this  patient. 

The  following  is  a  similar  case  dating  from  i8gr.  A  twelve-year- 
old  horse  was  brought  to  the  clinique  with  this  history :  About  three 
months  before,  its  forehead  was  seen  to  be  swollen  ;  the  swelling 
increased  gradually,  mastication  became  painful,  and  an  offensive 
discharge  occurred  from  the  right  nostril. 

The  right  side  of  the  face  showed  a  diffuse,  firm,  slightly  painful 
swelling,  not  extending  beyond  the  anterior  extremity  of  the  zygo- 
matic ridge  of  the  superior  maxillary  bone.  The  submaxillary 
gland  of  the  same  side  formed  a  hard  bosselated  mass,  moveable  in 
relation  to  the  skin,  but  very  adherent  to  the  deep  parts.  From  the 
right  nostril  a  greyish  ill-smelling  discharge  occurred.  By  separating 
the  wings  of  the  nostril,  a  greyish  tumour  could  be  seen  filling  the 
nasal  cavity  and  extending  forwards  between  the  turbinated  bones. 
On  examining  the  cavity  of  the  mouth,  the  portion  of  the  hard  palate 
extending  along  the  line  of  upper  molars  was  seen  to  be  occupied  by 
a  reddish,  exuberant,  granulating  swelling,  which  towards  the  middle 
of  the  mouth  almost  covered  half  the  space  between  the  rows  of  teeth. 
The  cheek  was  partially  filled  by  vegetations,  and  by  food  material 
in  a  putrefying  condition.  Several  of  the  molars  were  very  loose,  and 
their  alveoli  had  certainh'  been  destroyed. 

Though  swelling  of  the  forehead  was  relatively  little  pronounced, 
you  saw  that  the  changes  were  extensive.  The  diagnosis,  incurable 
tumour  of  the  maxilla,  was  patent  to  all.  Microscopic  examination  of 
a  fragment  of  new  tissue  removed  from  the  hard  palate  opposite  the 
second  molar  confirmed  this  diagnosis.  The  growth  was  a  lobulated 
epithelioma  of  the  pavement-epithelium  type.  Soon  afterwards  the 
animal  was  slaughtered.  I  was  able  to  obtain  the  head,  and  trace  the 
extent  of  the  lesions.  The  tumour  had  destroyed  almost  the  whole  of 
the  upper  maxilla,  the  anterior  portion  of  the  palatine  bone,  and  part 
of  the  turbinated  bones.  It  filled  the  middle  third,  and  part  of  the 
upper  third  of  the  right  nasal  cavity,  as  well  as  both  maxillary 
sinuses.  The  third  and  fourth  molars  were  completely  detached,  the 
second,  fifth,  and  sixth  hardly  retained  their  positions.  The  affection 
was  well  marked  in  the  submaxillary  lymphatic  glands,  which  pre- 
sented the  same  characters  as  the  tumour. 


TUMOURS  IN  THE  FACIAL  SINUSES  AND  CANCER  OF  THE  SUPERIOR  MAXILLA.     27 

The  case  we  have  just  seen  is  that  of  a  gelding  about  fifteen  years 
old.  Six  months  ago  it  showed  gradual  swelling  of  the  upper  left 
maxilla.  A  veterinary  surgeon  who  was  consulted  considered  this 
due  to  injury,  and  prescribed  treatment,  but  without  success.  The 
swelling  slowly  increased,  mastication  became  difficult,  and  the  breath 
from  the  left  nostril  stank.  These  symptoms  had  existed  about  two 
months  before  the  animal  was  brought  to  our  clinique. 

The  most  striking  feature  at  first  glance  was  the  asymmetry  of  the 
face.  The  cheek  muscles  were  atrophied.  The  prominence  of  the 
masseter,  usually  so  well  marked,  had  disappeared,  and  was  replaced 


<-^'^<fi/^ 


Fig.  5. — Pavement-celled  epithelioma  of  the  maxilla.     Transverse  section  of  the 
face  in  front  of  the  fifth  molar. 


by  a  distinct  depression.  In  the  region  of  the  superior  maxilla, 
between  the  zygomatic  process  and  the  orbital  cavity,  was  a  tumour  as 
large  as  a  man's  fist,  uniformly  hard  except  at  its  centre,  where  the 
skin  had  ulcerated,  and  allowed  of  fungous  vegetations  protruding. 
Examination  of  the  parts  was  painful,  and  caused  the  animal  to 
struggle.  From  the  left  nostril  ran  a  grumous  offensive  discharge^ 
the  amount  of  which  increased  with  exercise.  The  lymphatic  glands 
in    the    submaxillary  space    were    enlarged,  a    little    indurated    and 


28  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

painful,  but  moveable  under  the  skin.  The  mouth  was  offensive. 
On  examining  the  buccal  cavity,  considerable  destruction  of  mucous 
membrane  was  noted  on  the  left,  and  the  gum  on  either  side  of  the 
row  of  molars  was  covered  with  vegetations.  By  using  the  mouth-gag, 
the  second,  third,  and  fifth  molars  were  found  to  be  loose  and  implanted 
in  a  soft  tissue.  They  were  surrounded  with  decomposing  food.  The 
fourth  molar  had  fallen  out,  its  place  being  occupied  by  fungating  new 
tissue.  In  order  to  make  a  more  complete  examination  the  animal 
was  cast  and  chloroformed.  The  face  was  trephined  at  three  points 
around  the  centre  of  the  tumour.  The  large  opening  thus  made 
showed  the  greater  part  of  the  maxilla  to  be  destroyed,  and  exposed 
the  roots  of  the  molars,  whose  bony  alveoli  had  disappeared.  The 
second  and  fourth  molars  were  removed. 

Diagnosis  was  easy.  The  symptoms  were  due  to  a  tumour,  which 
had  invaded  the  greater  part  of  the  superior  maxillary  bone,  had  filled 
the  sinuses,  and  had  perforated  the  bony  palate.  Microscopic 
examination  showed  it  to  be  another  case  of  epithelioma  of  the 
pavement  epithelium  type. 

The  animal  was  slaughtered.  No  secondary  growths  could  be 
detected  in  the  viscera.  The  superior  maxilla  was  almost  completely 
destroyed.  The  first  molar  was  still  fairly  firm,  but  the  fifth  and  sixth 
yielded  to  gentle  traction.  The  new  growth  hardly  projected  above 
the  level  of  the  palate,  which,  however,  was  invaded  throughout  the 
entire  left  side,  from  its  posterior  border  to  a  point  level  with  the  first 
molar. 

You  see  that  these  three  cases  are  almost  similar,  the  only 
differences  being  the  position  and  extent  of  the  lesions.  In  all  three 
the  tumours  are  similar  in  nature  and  origin — are,  in  fact,  epithe- 
liomata  affecting  deep-seated  portions  of  the  maxilla.  Epithelial 
tumours  originating  in  the  mucous  membrane  of  the  mouth,  nose,  or 
sinuses,  certainly  occur,  but  are  rare  in  the  horse.  Those  most 
commonly  seen  in  this  region  usually  start  from  the  maxilla.  They 
undoubtedly  develop  from,  and  at  the  expense  of,  paradental  epi- 
thelial debris,  according  to  M.  Malassez's  theory  in  the  case  of  similar 
tumours  in  man.  Under  the  influence  of  hitherto  unrecognised 
stimuli,  the  cells  forming  these  small  tracts  of  tissue  may  at  any 
moment  commence  to  proliferate,  and  may  form  in  the  depths  of  the 
bone  a  tumour  which  afterwards  extends  towards  the  mouth  or 
sinuses,  most  frequently  towards  both  simultaneously.  Little  by 
little  the  cancer  destroys  the  walls  of  these  cavities  and  the  alveoli  of 
the  teeth.     Sometimes  it  excavates  in  the  bone  a  large  cavity,  lined 


TUMOURS  IN  THE  FACIAL  SINUSES  AND  CANCER  OF  THE  SUPERIOR  MAXILLA.     29 

with  epithelial  fungations.  This  form  has  been  termed  rodent  cancer 
of  the  maxilla.  Even  when  the  affection  is  discovered  early,  for 
example  at  the  moment  when  the  buccal  mucous  membrane  becomes 
ulcerated,  or  when  the  face  begins  to  show  deformity,  the  body  of 
the  maxilla  or  the  alveoli  of  the  teeth  have  already  undergone  extensive 
injury. 

You  must  guard  against  founding  your  prognosis  of  tumours  in  the 
region  of  the  sinuses  on  the  volume  of  the  swelling,  or  distortion  of 
the  facial  bones.  Whilst  epitheliomata  of  the  maxilla,  even  though 
hardly  visible,  are  of  the  greatest  gravity,  innocent  tumours  developed 
from  the  mucous  membrane  of  the  sinuses  may  press  against  the 
external  wall  of  the  cavity  containing  them,  thinning,  lifting,  and 
perforating  it,  and  finally  breaking  through  the  skin.  Such  benign 
tumours  can  be  operated  on  with  success.  The  animal  is  chloro- 
formed, the  invaded  cavities  freely  opened — most  frequently  the  two 
maxillary  sinuses  are  those  affected — and  the  new  growth  totally 
removed,  either  in  one  or  several  portions.  Haemorrhage  is  checked 
by  plugging,  or  the  use  of  the  cautery.  But  in  the  case  of  truly 
malignant  tumours  such  operations  are  unjustifiable,  and  the  practi- 
tioner who  wishes  to  avoid  compromising  his  reputation  will  not 
attempt  them. 

In  speaking  of  these  tumours  it  is  well,  in  animals  as  in  man,  to 
reserve  the  epithet  of  malignant  for  those  which  grow  rapidly,  invade 
neighbouring  tissues— bone  and  soft  parts — and  which  extend  to  the 
lymphatics  ;  to  those,  in  a  word,  whose  course  simulates  the  progress 
of  an  infectious  disease. 

I  may  summarise  the  practical  deductions  to  be  drawn  from  the 
cases  described  in  a  few  words  : — Tumours  developed  on  the  mucous 
membrane  of  the  sinus,  which  have  only  affected  the  bone  by  mechani- 
cally lifting  it,  or  by  exercising  on  it  permanent  prolonged  pressure, 
are  curable.  If  the  value  of  the  animal  justifies  intervention  they 
should  be  removed. 

When,  however,  the  new  growth  invades  tissues  indiscriminately 
and  has  partially  destroyed  the  walls  of  the  sinus,  or  affected  the 
alveoli  of  the  teeth,  without,  however,  seizing  on  the  lymphatic  glands, 
it  is  almost  always  of  the  nature  of  an  osteo-sarcoma,  and  interference 
is  not  advisable. 

Finally,  when  the  tumour  shows  metastatic  characters,  and  affects 
neighbouring  lymphatic  glands,  it  is  usually  a  malignant  epithelial 
tumour,  beyond  operation,  and  always  liable  to  return  if  ablation  is 
attempted. 


v.— THE    SURGICAL    TREATMENT    OF    CHRONIC 

ROARING. 

One  day  last  week  M.  L — ,  of  No.  12,  Place  Vendome,  Paris,  sent 
us  for  examination  a  horse  suffering  from  chronic  roaring,  asking 
whether  we  would  carry  out  on  this  .animal  the  operation  performed 
last  year  on  a  mare  belonging  to  his  neighbour,  M.  D — .  He  stated 
that  M.  D — 's  mare,  which  had  suffered  from  intense  roaring,  render- 
ing her  useless  before  operation,  was  at  that  moment  doing  good 
service,  and  that  M.  D —  was  very  well  pleased  with  the  result. 
I  was  not  at  the  clinique  on  that  day,  but  several  of  you  will 
remember  the  mare  in  question.  The  operation  indicated  was 
arytasnoidectomy. 

I  may  shortly  sketch  the  history  of  the  animal  thus  cured.  She 
was  an  Anglo-Norman  mare,  which  excited  much  attention  at  the 
horse  show  of  1893,  where  she  received  the  first  prize  for  harness 
horses.  Bought  towards  the  end  of  the  show  by  M.  D— ,  she  worked 
well  until  1895.  During  the  winter  of  1895-6  she  contracted  pneu- 
monia, and  on  return  to  work  was  found  to  have  become  a  roarer. 
She  was  unsuccessfully  treated  with  iodide  of  potassium.  The  roaring 
grew  so  marked  that  the  animal,  even  at  moderate  paces,  several  times 
fell  in  the  shafts.  M.  D —  took  the  advice  of  several  veterinary 
surgeons.  A  consultant  told  him  that  the  disease  was  incurable,  and 
that  he  would  have  to  dispose  of  the  mare.  M.  D —  replied  that  he 
valued  her  greatly,  and  that  he  had  heard  speak  of  an  operation  which 
without  the  use  of  a  tracheotomy  tube  had  several  times  rendered 
roaring  horses  useful.  He  was  informed  that  the  operation  did  not 
succeed  once  in  a  hundred  times. 

Having  been  thus  advised,  M.  D —  came  to  me  one  morning  at  the 
school,  and  asked  whether  I  would  consent  to  operate  on  his  mare. 
After  having  exactly  informed  him  of  the  value  of  surgical  treatment 
for  roaring,  I  proposed  to  first  perform  the  small  operation,  and  in 
case  of  failure  to  perform  the  other — terms  which  he  accepted. 

On  the  i8th  January  I  performed  partial  cricoidectomy.  Return- 
ing to  work  on  the  8th  February  the  mare  roared  to  the  same  extent 
as   before    operation.       Being   sent    back    here  on   the   5th   March  I 


THE    SURGICAL    TREATMENT    OF    CHRONIC    ROARING.  3 1 

removed  the  left  arytsenoid.  She  once  more  went  to  work  at  the 
commencement  of  May,  since  when  she  has  continued  without  inter- 
ruption. At  the  present  time  she  occasionally  gives  a  few  dry  coughs, 
but  no  longer  roars  at  a  trot.  At  a  very  fast  pace  she  produces  a 
slightly  abnormal  noise,  otherwise  without  importance,  for  it  is  not 
accompanied  by  any  distress  or  interference  with  respiration. 

This  is  not  an  exceptional  case.  Since  the  first  results,  which  I 
published  in  i8go,  a  number  of  my  patients  have  proved  to  be  cured 
and  others  to  be  improved.  During  the  last  few  months  several 
animals  have  returned  here,  in  v/hich  after  intervals  of  a  year, 
eighteen  months,  or  two  years,  the  good  effects  are  found  to  have 
been  maintained. 

These  results  are  interesting,  if  only  from  the  point  of  view  of  the 
surgery  of  the  larynx.  They  show  that  deep,  extensive  wounds  of  the 
larynx  readily  heal  without  pulmonary  complications,  and  that  intra- 
laryngeal  wounds  with  loss  of  substance  may  cicatrise  without  pro- 
ducing contraction  of  the  air-tube.  Considering  that  the  condition  for 
which  operation  is  performed  was  formerly  regarded  as  absolutely 
incurable  they  are  encouraging,  for  if  failures  are  still  frequent,  we 
now  know  how  to  avoid  various  accidents  to  which  the  operation 
gave  rise  at  the  time  when  I  commenced  to  study  it.  This  is  not  one 
of  those  operations  which  only  became  possible  after  the  discovery 
of  antisepsis.  The  progress  effected  is  simply  due  to  more  perfect 
technique. 

On  previous  occasions  I  have  spoken  of  the  experiments  made 
more  than  half  a  century  ago  by  Gunther  with  the  object  of  curing 
roaring.  I  have  also  mentioned  Moller's  researches,  of  which  I  gave 
a  resume  in  my  work  in  i8gi.  Among  the  various  methods  of  opera- 
tion proposed  by  these  veterinary  surgeons  is  one  whose  efficacy  is 
undoubted,  and  which  deserves  preference  before  all  others.  This 
method  is  arytsenoidectomy. 

In  the  great  majority  of  cases  I  have  treated  I  performed  arytanoi- 
dectomy  pure  and  simple,  following  the  method  described  in  my  work* 
and  in  my  text-book  on  surgical  treatment.  I  have  since  somewhat 
modified  the  instruments  and  technique.  To  ensure  not  injuring  the 
mucous  membrane  of  the  trachea  by  undue  compression,  I  replace 
the  rubber  balloon  surrounding  the  Trendelenburg  cannula  with 
plaited  gauze,  fixed  to  the  tracheotomy  tube  by  ligatures.  I  only 
cut  through  the  cricoid  cartilage   and  first  ring  of  the  trachea.       I 

*   See  '  Roaring  in  Horses,'  by  P.  J.  Cadiot,  translated  by  T.  J.  W.  Dollar. 


32  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

incise  the  laryngeal  mucous  membrane  along  the  superior  and  posterior 
margins  of  the  arytaenoid  a  little  within  their  borders.  As  a  dressing 
I  place  in  the  larynx  two  rectangular,  flattened  tampons  of  gauze  on 
edge,  which  I  fix  by  passing  through  them  the  silk  threads  of  the 
suture  used  to  unite  the  muscle.  I  remove  the  dressing  and  tracheo- 
tomy tube  at  the  end  of  twenty-four  hours.  For  the  first  few  days  I 
keep  the  trachea  open  and  the  wound  exposed,  by  passing  through 
the  centre  of  the  skin  and  muscle  forming  the  lips  of  the  wound  two 
threads,  which  are  tied  together  above  the  neck.  Whilst  sparing 
the  mucous  membrane  covering  the  superior  and  posterior  margins 
of  the  arytsenoid  as  much  as  possible,  I  slightly  changed,  though 
I  ought  to  say  without  much  benefit,  the  method  of  removing  the 
cartilage.  In  certain  cases  I  preserved  a  narrow  band  of  the  mucous 
membrane  covering  the  anterior  margin  of  the  cartilage.  In  others, 
where  the  larynx  was  particularly  narrow,  I  made  the  incision  opposite 
the  inferior  margin  of  the  arytaenoid  a  little  larger,  extending  it  to 
the  mucous  membrane  and  the  upper  part  of  the  vocal  cord.  In 
others,  again,  I  removed  the  greater  part  of  the  articular  angle  of 
the  arytaenoid  with  cutting  forceps.  Except  for  this  latter  modifica- 
tion, I  consider  it  very  important  to  limit  as  far  as  possible  the  area 
of  incisions  in  the  laryngeal  mucous  membrane ;  not  to  extend 
towards  the  region  of  the  oesophagus  when  detaching  the  upper 
surface  of  the  arytsenoid  ;  and  not  to  wound  either  the  portion  of  the 
arytsenoid  left  or  the  vocal  cord. 

With  a  little  practice  the  manipulations  in  arytaenoidectomy  are 
easity  performed,  even  without  anaesthesia  ;  but  these  manipulations 
cannot  be  carried  out  correctly,  or  with  the  necessary  certainty,  by  an 
unpractised  or  clumsy  hand. 

When  the  wound  resulting  from  ablation  of  the  arytaenoid  heals 
regularly,  when  granulation  is  not  excessive  or  new  cicatricial  tissue 
exuberant,  the  entrance  to  the  larynx  remains  enlarged ;  the  result 
is  then  good. 

In  favourable  cases  the  course  of  events  is  as  follows  : — The 
mucous  membrane  at  the  four  margins  of  the  wound  left  by  removal 
of  the  arytaenoid  is  far  from  being  equally  moveable  ;  the  superior  and 
inferior  margins  of  this  wound  cannot  be  united  by  suture,  but  it  is 
easy  to  bring  the  anterior  and  posterior  in  contact  without  dissection 
and  without  tearing  ;  the  reason  being  that  the  anterior  edge  is  very 
moveable  and  can  easily  be  drawn  towards  the  posterior,  thus  covering 
the  whole  wound.  If  left  to  itself  the  wound  granulates  over  its  entire 
surface,  and  the  cicatricial  tissue  in  contracting  draws  the  anterior 
margin  much  nearer  the  centre  than   it   does  the   others.     It  is  the 


THE    SURGICAL    TREATMENT    OF    CHRONIC    ROARING.  33 

anterior  margin,  therefore,  which  principally  restores  the  covering  of 
the  parts ;  and  when  repair  occurs  regularly,  without  excessive  new 
tissue  formation,  the  upper  portion  of  the  larynx  is  and  remains 
distinctly  concave  at  its  left  side,  /.  c.  at  the  site  of  operation.  Under 
these  conditions  the  vocal  cord  can  neither  be  pushed  nor  drawn 
towards  the  median  line.  It  is  fixed  in  the  position  it  occupies  or 
drawn  slightly  outwards. 

Unfortunately,  our  subjects  do  not  voluntarily  allow  anything  to  be 
done.  It  is  impossible  to  follow  the  progress  of  the  wound,  to  super- 
intend the  healing,  or  to  repress  the  excessive  granulations  which  may 
form,  and  thus  to  obtain  a  flat  cicatrix — an  essential  condition  for  the 
disappearance  or  diminution  of  roaring. 

Attempts  have  been  made  to  still  further  enlarge  the  passage  by 
excising,  along  with  the  arytgenoid,  either  the  vocal  cord,  or  the  vocal 
cord  and  internal  wall  of  the  laryngeal  ventricle.  These  are  old 
methods.  Ablation  of  the  arytaenoid  and  of  the  vocal  cord  is  not 
nearly  so  valuable  as  simple  ar3'taenoidectomy.  After  a  large  experience 
I  regard  the  benefit  sought  by  removing  the  vocal  cord  as  illusory. 
The  mucous  wound  is  greatly  enlarged,  and  its  inferior  part,  whence 
the  cord  is  removed,  is  precisel}^  that  which  most  readily  vegetates 
and  gives  rise  to  excessive  granulations. 

There  remains,  then,  arytasnoidectomy,  completed  by  removal  of 
the  internal  wall  of  the  laryngeal  ventricle.  The  advantage  of 
enlarging  the  air  inlet  throughout  its  extent,  without  sensibly  in- 
creasing the  surface  of  the  excision  wound,  was  claimed  for  this  opera- 
tion. It  has  been  given  up  because  most  horses  upon  which  it  was 
performed  died  from  mechanical  pneumonia,  due  to  passage  of  particles 
of  food  into  the  lungs.  I  avoided  this  by  feeding  my  patients  in  the 
same  way  as  human  beings  who  have  undergone  arytaenoidectom}-,  and 
by  exercising  the  same  care  after  operation. 

The  procedure  was  as  follows  : — I  commenced  by  performing  ary- 
taenoidectomy,  following  the  ordinary  method  and  suturing  the  borders 
of  the  wound.  I  afterwards  passed  the  index  finger  into  the  ventricle 
of  the  larynx  ;  with  one  limb  of  a  pair  of  straight  scissors,  introduced 
into  the  ventricle,  I  vertically  divided  the  inner  wall  of  the  latter 
throughout  its  depth.  Grasping  the  anterior  flap  with  forceps,  I 
partially  excised  it  with  curved  scissors,  avoiding  injury  to  the 
epiglottis.  I  next  grasped  the  posterior  flap,  covered  by  the  vocal 
cord,  in  the  same  way,  and  removed  it  from  below  upwards  with  a 
button-pointed  bistoury.  The  dressing  and  the  subsequent  precau- 
tions adopted  were  similar  to  those  after  arytaenoidectomy. 

c 


34  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

This  operation  always  gave  bad  results. 

Of  the  various  methods  suggested,  arytsenoidectomy  not  only  causes 
the  fewest  possible  complications,  but  also  gives  the  greatest  number 
cf  lasting  successes. 

Like  all  bold  operations,  like  all  surgical  innovations  directed 
against  diseases  previously  considered  incurable,  arytsenoidectomy  has 
its  drawbacks  and  dangers  ;  but  the  fact  remains,  and  cannot  be  gain- 
said, that  it  renders  useful  for  various  kinds  of  work  a  number  of 
roarers  otherwise  condemned  to  tracheotomy. 

Like  other  methods  of  treatment,  it  must  not  be  expected  to  effect 
too  much,  and  those  persons  are  certainly  over-exacting  who,  after 
having  all  their  lives  proclaimed  the  absolute  incurability  of  chronic 
laryngeal  roaring,  reproach  it  for  its  uncertainty  and  for  its  infrequent 
success,  as  if,  instead  of  advancing  a  little  even  by  the  process  of  grop- 
ing one's  way,  it  were  preferable  to  stand  still. 

It  is,  I  feel  sure,  superfluous  to  labour  the  point,  and  I  conclude  by 
repeating  with  Lanzilotti  : 

"  E  indubitato  die  iiiolti  cavalli  sono  guariti !  " 
[Undoubtedly  many  horses  are  cured.] 


VI.— ACUTE    INGUINAL    HERNIA. 

Last  month  an  entire  horse  left  here  for  treatment  underwent  two 
grave  operations  on  the  same  day,  one  of  which  was  rendered  necessary 
by  a  quite  unexpected  accident.  We  had  cast  the  animal  in  the 
morning  to  operate  for  necrosis  of  some  of  the  horn-secreting  tissues 
resulting  from  a  prick  in  shoeing.  The  same  evening  we  had  to  cast  it 
again  :  it  had  a  strangulated  inguinal  hernia — a  hernia  certainly  due  to 
the  violent  struggles  it  had  made  during  the  first  operation.  The 
history  of  this  horse  is  interesting  for  a  double  reason,  of  which  you 
will  judge  later. 

It  was  brought  for  examination  on  the  i6th  April  because  it  went 
lame  on  the  off  fore-leg,  and,  to  assist  us  in  diagnosis,  the  driver 
stated  that  the  animal  had  fallen  the  night  before  on  the  right  side, — 
that  before  this  fall  it  had  not  shown  the  slightest  defect,  but  that  it 
had  gone  lame  immediately  afterwards. 

I  may  add  that  it  was  brought  here  by  its  regular  driver,  who 
mentioned  that  he  had  found  the  shoulder  painful,  that  he  regarded  it 
as  the  seat  of  lameness,  and  that  the  farrier  who  had  been  referred  to 
said  the  same  thing.  We  thus  had  to  guide  us  the  opinion  of  two 
experts. 

I  examined  the  horse  before  you.  I  showed  you  that  the  different 
portions  of  the  limb  exhibited  no  recent  lesion  to  explain  the  lameness, 
and  that  the  shoulder  especially  was  neither  swollen  nor  painful. 
Rather  more  restlessness  was  certainly  shown  on  this  side  when  the  two 
shoulders  were  comparativel)^  examined,  but  that  was  due  to  a  slight 
stimulant  application  which  had  been  made,  and  possibly  also  to  the 
manipulation,  pressure,  and  traction  carried  out  by  the  two  colleagues. 
Percussion  on  the  foot,  however,  produced  very  evident  flinching.  On 
lightly  tapping  around  the  hoof  near  the  shoe  the  animal  responded 
by  lifting  the  foot.  A  similar  test  applied  to  the  other  foot  produced 
no  result.  On  removing  the  shoe — especially  when  I  lifted  the  inner 
branch  with  the  pincers — the  animal  again  showed  signs  of  pain. 
Similarly,  when  I  "tried  the  foot  round  "  by  compressing  the  circum- 
ference, the  animal  was  uneasy.  The  quarters  and  the  inner  heel  were 
especially  sensitive.     I  then  proceeded  to  cut  a  groove  along  the  white 


36  CLINICAL    VETERINARY    .MEDICINE    AND    SURGERY. 

line  and  expose  the  nail-holes,  the  animal  meanwhile  showing  pain 
and  drawing  away  the  foot,  and  in  a  moment  it  became  clear  that  the 
last  nail  was  badly  placed.  On  cutting  down,  the  horn  soon  appeared 
yellowish  and  infiltrated.  Finally  a  little  greyish  pus  exuded.  The 
horse  had  been  pricked. 

I  thoroughly  thinned  the  inner  heel,  sole,  bars,  and  posterior 
portion  of  the  quarter;  in  order  to  diminish  compression  of  the  injured 
parts  I  slightly  enlarged  the  opening  in  the  sole,  washed  out  the 
purulent  cavity  with  an  antiseptic  solution,  and,  as  is  our  custom  in 
cases  of  this  kind,  enveloped  the  foot  in  a  thick  layer  of  tow,  moistened 
with  five  per  cent,  solution  of  sulphate  of  copper. 

The  horse  at  once  appeared  to  be  relieved,  and  lameness  had 
diminished.  During  the  evening,  and  following  days,  the  tow  dressing 
was  again  moistened  with  sulphate  of  copper  solution.  For  some  time 
the  condition  remained  practically  unchanged,  but  on  the  morning  of 
the  20th  lameness  was  excessive,  and  the  animal  showed  evidence  of 
shooting  pains  in  the  foot.  Some  complication  existed,  and  it  became 
necessary  to  interfere  more  actively. 

The  quarter  having  been  thinned,  the  animal  was  cast  on  the  right 
side,  the  affected  foot  released  from  the  hobbles,  and  fastened  above  the 
hock  of  the  same  side.  Opposite  the  point  where  the  nail  had  pene- 
trated I  removed  the  entire  horny  wall  for  a  distance  of  two  to  two 
and  a  half  inches  in  breadth,  corresponding  to  the  area  over  which  I 
concluded  the  sensitive  tissues  had  become  necrotic.  In  the  lower 
third  the  sensitive  laminae,  though  thickened,  infiltrated,  and  bright 
red  in  colour,  were  only  inflamed,  but  between  this  part  and  the  coronet 
was  a  black  gangrenous  patch  as  large  as  a  two-shilling  piece,  dotted 
over  with  greyish  points.  I  removed  this  dead  piece  of  tissue,  exposing 
at  its  upper  part  the  lateral  cartilage  and  below  a  narrow  strip  of  the 
pedal  bone.  I  excised  a  thin  layer  of  the  cartilage,  which  already 
appeared  of  a  light  green  colour,  and  curetted  the  bone,  the  superficial 
layers  of  which  were  infiltrated  with  pus.  Finally  I  irrigated  the 
w^ound  with  a  i  in  1000  solution  of  sublimate,  powdered  it  with  iodo- 
form, and  covered  the  parts  with  a  surgical  wool  dressing.  The 
operation  and  dressing  had  lasted  about  half  an  hour. 

On  rising  the  horse  walked  much  more  comfortably  than  before 
operation.  The  foot  was  not  lifted  in  the  same  restless  way  ;  the 
lancinating  pains  had  ceased.  It  was  returned  to  its  box,  and  at  once 
began  to  eat.     This  was  about  10.30  a.m. 

At  I  o'clock  in  the  afternoon  my  assistant  came  to  sa}'  that  the 
animal  was  showing  signs  of  acute  colic.  Some  of  you  had  noted  a 
•distinct  difference  in  the  two  spermatic  cords,  but  did  not  suspect  the 


ACUTE    INGUINAL    HERNIA.  37 

existence  of  acute  inguinal  hernia.  You  will  remember  that  on  the 
first  examination  I  was  able  to  enlighten  you  on  this  point.  Whilst 
the  left  cord  was  relaxed  and  free,  and  its  different  parts  could  readily 
be  distinguished  with  the  fingers,  the  right  was  retracted,  enlarged, 
and  felt  as  though  inflated  ;  the  two  principal  parts,  the  vascular  cord 
and  the  vas  deferens,  could  no  longer  be  distinguished.  At  the  first 
touch  one  could  feel  that  the  distended  vaginal  sheath  contained,  in 
addition  to  the  spermatic  cord,  a  loop  of  intestine  swollen  by  strangu- 
lation. The  clinical  characters  were  such  as  to  leave  no  doubt  regard- 
ing the  condition. 

The  horse  was  cast  on  the  left  side,  chloroformed,  the  off  hind 
leg  abducted  and  fixed  with  lengths  of  webbing  by  the  usual  method. 
Some  attempts  at  taxis  having  failed,  I  was  obliged,  after  preparing 
the  parts,  to  perform  the  operation  for  strangulated  inguinal  hernia — 
kelotomy. 

You  will  recall  the  stages — free  incision  of  the  scrotum  and 
dartos  in  the  long  axis  of  the  hernial  swelling  ;  isolation  of  the  mass 
formed  of  deeper  seated  tissues,  the  vaginal  sheath  and  its  contents, 
by  breaking  down  the  subdartoid  connective  tissue,  this  isolation  being 
prolonged  upwards  as  far  as  possible  ;  puncture  of  the  vaginal  sheath 
at  its  posterior  part,  where  its  parietal  la}-er  is  in  contact  with  the 
testicle  ;  laying  open  the  base  of  the  vaginal  sheath  parallel  to  the 
long  axis  of  the  testicle  for  a  distance  corresponding  to  the  entire 
length  of  the  latter  ;  seizing  the  edges  of  the  sheath  by  means  of  broad- 
jawed  forceps  ;  incision  of  the  outer  edge  of  the  hernial  ring  with  a 
button-pointed  bistoury ;  washing  of  the  extravasated  intestine  with 
boiled  water  ;  reduction  commencing  with  the  upper  parts  of  the  loop; 
re-application  of  the  vaginal  sheath  over  the  cord  ;  torsion  of  these 
parts  ;  application  of  curved  clams ;  finally,  removal  of  the  testicle  by 
dividing  the  cord  half  an  inch  below  the  clams. 

In  this  horse  the  loop  of  herniated  intestine,  situated  as  usual  in 
front  of  and  inside  the  cord,  measured  about  ten  inches  in  length  ;  it 
was  severely  congested  and  distended  ;  its  walls  were  infiltrated  with 
fluid,  but  were  firm,  resistent,  and  not  abraded,  and  there  was  there- 
fore no  fear  of  their  tearing  through  under  cautious  manipulation. 
The  first  incision  not  having  given  sufficient  space,  I  reintroduced  the 
left  index  finger  into  the  vaginal  sheath  as  high  as  the  hernial  ring, 
and  increased  it.  xAlthough  the  opening  was  sufficiently  enlarged,  the 
intestine  returned  with  difficulty.  1  therefore  had  the  horse  placed  on 
its  back,  and  whilst  one  of  you  exercised  traction  on  the  upper  part  of 
the  herniated  loop  through  the  rectum,  I  recommenced  taxis.  Re- 
duction was  complete  in  a  few  minutes. 


38  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

When  the  herniated  loop  of  intestine  is  situated  outside  the  cord  it 
is  sometimes  difficult  to  incise  the  hernial  ring,  and  great  caution  is 
then  necessary  to  avoid  injuring  the  cord  itself.  Last  year  we  ope- 
rated on  a  bubonocele  of  this  character  which  had  existed  for  twelve 
hours.  Limited  to  the  upper  half  of  the  inguinal  canal,  the  loop  was 
situated  in  front  of  and  external  to  the  cord.  On  account  of  the 
danger  of  injuring  the  intestine,  which  was  greatly  distended  by  gas, 
I  was  obliged  to  make  several  attempts  before  I  succeeded  in  dividing 
the  ring.  Reduction  was  easy,  and  the  animal  recovered,  practically 
without  showing  fever. 

I  return  to  our  last  patient.  When  taken  back  to  his  box  he  was 
still  dull  and  stupid  ;  but  the  symptoms  due  to  chloroform  gradually 
disappeared.  In  the  evening  he  ate  his  food,  and  showed  no  abnormal 
symptoms.     At  8  o'clock  the  temperature  was  ioo'4°  F. 

During  the  following  days  his  general  condition  remained  perfectly 
satisfactory ;  the  fever  was  moderate,  the  temperature  not  rising 
beyond  i03"i°  F.  The  horse  placed  weight  on  the  foot,  and  lanci- 
nating pain  was  absent.  Treated  with  sublimate  irrigations  the  in- 
guinal wound  suppurated  very  little,  and  the  swelling  did  not  exceed 
that  usual  after  castration.  The  clams  were  removed  on  the  sixth 
day. 

Healing  of  both  operative  wounds  occurred  without  complication 
or  accident  of  any  sort.  On  the  17th  May  the  patient  left  the  hospital. 
Some  days  afterwards  he  returned  to  work. 

This  case  shows  that  injuries  of  the  fibro-cartilage  of  the  foot  may 
heal  rapidly  and  without  complications.  It  was  long  taught  that 
necrosis  of  the  central  or  anterior  parts  of  this  cartilage,  or  even  their 
extensive  exposure  by  removal  of  necrosed  sensitive  laminae,  neces- 
sitated removal  of  the  cartilage  in  toto.  This  rule,  as  you  see,  admits 
of  exceptions.  In  our  patient  the  cartilage  was  freely  exposed  in 
front ;  its  superficial  layers  exhibited  the  greenish  colour  peculiar  to 
necrosis,  and  yet  partial  excision  sufficed.  The  cartilage  healed  like 
the  podophyllous  membrane  which  normally  covers  it. 

Several  years  ago  I  published  a  number  of  cases  showing  that 
wounds  of  the  feet  involving  the  fibro-cartilages  could  be  perfectly 
cured,  without  subsequent  necrosis  and  without  complication,  by 
simply  removing  the  infected  or  mortified  parts  of  the  cartilage,  and 
that  success  can  be  obtained  whatever  the  point  at  which  the  fibro- 
cartilage  is  wounded  or  necrotic.  Operations  on  the  horse's  foot 
especially  show  the  great  value  of  modern  surgical  methods— antisepsis 
and  the  use  of  surgical  dressings. 


ACUTE   INGUINAL   HERNIA.  39 

But  this  is  not  the  principal  point  to  which  I  wish  to  draw  your 
attention.  The  most  important  thing  to  bear  in  mind  is  the  possible 
occurrence  of  such  grave  accidents  as  that  which  overtook  our  horse 
whilst  I  was  operating  on  the  foot,  the  occurrence  of  hernia  from 
casting.  Luckily  such  things  are  rare.  Still  it  is  necessary  to  know 
that  they  may  occur  in  order  to  recognise  and  remedy  them  in  time. 

This  accident  is  the  second  I  have  noted  among  injured  animals 
in  my  clinique.  I  saw  the  first  case  in  January,  1889,  in  a  horse 
operated  on  for  picked-up  nail  of  the  near  fore-limb.  The  animal  was 
cast  on  the  right  side.  In  his  case  hernia  occurred  on  the  left  side. 
Its  presence  was  indicated  as  usual  by  colic,  and  the  condition  was 
diagnosed  three  hours  after  occurrence.  Performed  rapidly  and  under 
good  conditions  the  operation  succeeded. 

It  is  not  always  so.  When  sick  animals  are  not  watched  with 
sufficient  closeness  hernia  may  fail  to  be  recognised  until  too  late,  or 
pain  resulting  from  strangulation  of  the  intestine  may  be  referred  to 
the  operation  which  has  been  performed,  the  real  cause  not  being 
revealed  until  post-mortem  examination.  Even  here  I  saw  a  case  of 
this  character  some  seven  or  eight  years  ago  in  a  horse  operated  on  at 
the  school,  and  at  once  removed  by  its  owner,  who  lived  in  the  neigh- 
bourhood. The  owner  noted  that  the  animal  was  suffering  from  colic, 
but  as  it  had  great  difficulty  in  walking  it  was  treated  at  home  with 
some  nostrum.  No  one  suspected  for  a  single  instant  the  existence  of 
hernia. 

I  conclude  by  formulating  the  warning  to  be  drawn  from  the  above 
facts  :  —  Should  an  entire  horse  soon  after  having  been  cast  for  opera- 
tion show  signs  of  colic,  bear  in  mind  the  possible  existence  of  hernia  ; 
compare  the  two  inguinal  regions,  and  in  proportion  as  pain  persists 
direct  more  and  more  attention  to  the  state  of  these  parts. 


VII.— DEEP-SEATED    INGUINAL   ABSCESS   AFTER 
CASTRATION. 

During  the  holidays  we  operated  on  an  Enghsh-bred  five-year- 
old  horse  whose  case  was  so  instructive  from  the  clinical  point  of 
view,  and  offered  such  peculiarities,  as  to  merit  some  remark. 

The  horse  was  castrated  during  the  early  part  of  May,  i.  e.  more 
than  five  months  ago.  The  operation  was  performed  by  the  covered 
method,  with  clams.  The  wounds  healed  slowly,  that  on  the  left  side 
not  closing  entirely,  and  a  fistulous  wound  persisted,  due,  as  it  was 
thought,  to  "  scirrhous  cord."  A  veterinary  surgeon,  being  consulted 
regarding  this  sinus,  first  of  all  prescribed  antiseptic  injections.  In  a 
month's  time,  seeing  that  they  had  no  result,  he  cast  the  animal,  explored 
the  inguinal  region,  and  not  finding  any  induration  of  the  left  cord, 
suggested,  as  a  temporary  measure,  to  continue  the  injections  for  a 
further  time.  New  symptoms  appeared ;  the  animal's  movements 
became  impeded  ;  the  near  hind  leg,  which  was  slightly  swollen,  was 
advanced  with  difficulty,  and  with  a  circular  swinging  movement 
(abduction).  The  appetite  remained  fair,  but  the  animal  lost  flesh, 
and  its  coat  appeared  dull.  M.  Weber  was  asked  to  examine  it.  He 
was  struck  by  the  interference  with  movement  of  the  near  hind  limb, 
and  although  swelling  of  the  perinseum  was  little  marked,  and  the 
purulent  discharge  trifling,  he  advised  that  fresh  surgical  treatment 
was  necessary.     The  horse  entered  our  clinique  on  the  27th  August". 

I  had  only  been  told  part  of  this  history  when,  two  days  later,  I 
had  the  animal  cast,  thinking  we  had  to  deal  with  a  simple  scirrhous 
condition,  situated  more  or  less  high  in  the  cord.  The  inguinal  region 
was,  as  I  have  just  said,  little  swollen,  but  showed  diffuse  induration, 
extending  forwards  over  the  abdominal  region  beyond  the  opening  of 
the  sheath.  Having  passed  a  director  and  laid  open  the  fistula  in 
front  and  behind,  I  only  found  a  purulent  cavity  the  size  of  an  egg, 
situated  at  the  lower  part  of  the  fistula.  I  incised  the  fibrous  layer 
covering  the  inguinal  canal,  the  entrance  of  which  I  explored  without 
discovering  anything  abnormal.  The  sinus  and  abscess  could  not 
explain  the  swelling  of,  nor  the  difficulty  in  moving  the  near  hind  leg. 


DEEP-SEATED    INGUINAL    ABSCESS    AFTER    CASTRATION.  41 

The  diffuse  induration  about  the  wound  gave  one  the  impression  of  a 
new  growth,  so  that  for  a  moment  1  fancied  we  might  be  deahng  with 
an  epithehal  tumour  developed  in  the  perinaeal  region,  and  extending 
far  forwards  in  the  abdominal  wall. 

Having  enlarged  the  fistulous  track,  I  asked  M.  Weber  to  examine 
the  parts,  and  explore  the  fistula  and  abscess  cavity.  He  found 
nothing  to  explain  the  symptoms  previously  noted.  Nevertheless  we 
decided  not  to  make  a  deeper  exploration  at  the  time.  I  curetted  the 
walls  of  the  abscess,  excised  a  fragment  of  dead  tissue  for  micro- 
scopical examination,  washed  out  the  wound  with  an  antiseptic 
solution,  and  allowed  the  animal  to  rise.  During  the  evening  the 
operative  wound  was  washed  out  several  times  with  sublimate  solution. 
Histological  examination  of  the  tissue  removed  showed  that  the  lesion 
was  of  an  inflammatory  character,  at  least  at  the  point  from  which  the 
fragment  had  been  removed. 

Next  day  the  patient's  general  condition  was  little  changed.  The 
neighbourhood  of  the  wound  was  somewhat  oedematous.  Wishing  to 
examine  the  state  of  the  upper  inguinal  region  and  intra-abdominal 
portion  of  the  cord,  I  had  the  animal  fixed,  without,  however,  casting 
it.  The  hind  limbs  hobbled,  I  proceeded  to  rectal  exploration.  In 
the  pre-pubic  zone,  opposite  the  left  inguinal  ring,  I  found  a  kind  of 
diffuse,  rounded,  smooth -surfaced  swelling,  larger  than  a  man's  two 
fists,  and  about  four  inches  thick.  This  swelling  was  indolent  or 
nearly  so,  and  uniforml}'  hard.  No  fluctuating  point  could  be  dis- 
covered with  the  fingers.  The  cord  which  emerged  from  it  was 
scarcely  enlarged.  These  are  not  the  characters  of  an  abdominal 
scirrhus  ;  in  that  affection  the  neighbourhood  of  the  inguinal  ring  is 
seldom  much  swollen,  whilst  the  cord  itself  is  large  and  hard. 

Funiculitis,  therefore,  having  been  eliminated,  with  what  condition 
had  we  to  deal  ?  It  could  only  be  a  tumour  or  an  abscess.  The 
absence  of  pain  on  pressure,  uniform  hardness,  and  slightly  bosselated 
surface  of  the  swelling  rather  indicated  a  new  growth  than  an  abscess. 
On  the  other  hand,  the  swelling  of  the  corresponding  hind  limb,  and 
the  interference  noted  in  regard  to  movement,  might  be  explained  b}- 
either  theory,  on  the  basis  of  the  disease  having  extended. 

On  being  informed  of  the  discoveries  I  had  made,  and  of  the  gravit}' 
of  the  condition,  the  owner  granted  me  full  permission  to  operate 
further  if  I  thought  it  advisable.  The  following  days  the  swelling  of 
the  inguinal  region  remained  stationary,  but  that  of  the  limb  gradually 
increased.  The  temperature  oscillated  between  ioi*3°  and  102*8"  F., 
in  addition  to  which  there  was  depression  and  loss  of  appetite. 

The  5th  September,  after  examining  the  sw^elling  per  ycctiiin,  and 


42  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

discovering  that  it  showed  the  same  characteristics  as  before,  I  cast 
the  horse  on  the  right  side,  and  drew  the  left  hind  hmb  as  far  out- 
wards as  the  swelhng  allowed.  The  inguinal  region  and  surrounding 
parts  were  washed  with  warm  water  and  soap,  and  afterwards  irri- 
gated with  sublimate  solution.  With  a  bistoury  I  enlarged  the  wound 
in  the  direction  of  the  long  axis  of  the  inguinal  ring,  cutting  through 
the  layer  of  hardened  tissue  surrounding  the  edges  of  the  ring.  A  few 
vessels  which  bled  rather  freely  were  picked  up  with  artery  forceps. 
Having  thus  opened  the  inguinal  canal,  I  enlarged  the  space  by 
breaking  down  the  connective  and  fibrous  tissue  which  fills  its  lower 
part.  Arrived  at  its  middle  portion  without  finding  any  traces  of  the 
spermatic  cord,  I  was  arrested  by  a  strong  partition  running  obliquely 
from  above  downwards  and  backwards,  a  partition  which  projected  at 
its  centre  point,  and  through  which  I  distinctly  made  out  fluctuation. 
With  a  sudden  thrust  of  the  left  index  finger  perpendicular  to  the 
general  surface  of  the  centre  of  this  partition,  I  perforated  it.  A  flood 
of  whitish,  creamy  pus  immediately  escaped  through  the  lower  inguinal 
ring.  To  enlarge  the  aperture  I  cut  through  the  lower  part  of  the 
partition  with  a  bistoury.  The  abscess  cavity  was  enormous,  extend- 
ing particularly  in  the  direction  of  the  inguinal  space.  It  did  not 
contain  four  quarts  of  pus,  as  the  prosector  entrusted  with  the  dressing 
has  stated,  but  certainly  at  least  two  quarts. 

The  pocket  was  washed  out  with  warm  2  per  cent,  creolin  solution. 
Bleeding,  which  at  first  had  been  rather  severe,  soon  ceased.  A  large 
drainage-tube  was  placed  in  the  inguinal  canal,  its  upper  end  entering 
the  cavity  of  the  abscess.  The  lips  of  the  incision  were  brought 
together  with  four  sutures,  one  of  which  was  passed  through  the 
drainage-tube  itself,  about  two  inches  from  its  lower  extremity. 

On  rising  the  animal  appeared  to  be  greatly  relieved,  as  one  may 
very  well  imagine,  and  when  returned  to  its  box  at  once  began  to  eat. 
During  the  evening  the  pus  cavity  was  again  twice  washed  out  through 
the  drainage-tube. 

Next  day  the  general  condition  was  greatly  improved.  The  animal 
had  eaten  all  its  food ;  weight  was  firmly  placed  on  the  limb,  which, 
however,  was  still  swollen,  and  the  temperature  was  only  a  few  tenths 
of  a  degree  above  normal. 

During  the  following  days  improvement  steadily  continued.  The 
swollen  limb  gradually  diminished  in  size.  As  in  most  cases  of  infected 
wounds  in  the  inguinal  region,  a  fairly  large  oedematous  swelling 
developed  around  the  surgical  incision,  without,  however,  showing  any 
disquieting  character.  Treatment  was  confined  to  washing  out  the 
abscess  cavity  with  disinfectants. 


DEEP-SEATED    INGUINAL    ABSCESS    AFTER    CASTRATION.  43 

Up  to  the  13th  September  suppuration  remained  abundant,  and  the 
sweUing  around  the  wound  considerable,  but  the  other  symptoms — 
especially  the  serous  infiltration  of  the  limb  and  difficulty  in  movement 
■ — steadily  diminished.  On  the  i8th  the  intra-abdominal  swelling  was 
limited  to  the  cord,  which  was,  however,  hard,  conical  in  shape,  and 
smooth  on  the  surface. 

From  that  date  up  to  the  30th  September  the  wound  gradually 
contracted,  its  surroundings  diminished  in  size  by  re-absorption  of  the 
interstitial  exudate,  and  the  purulent  discharge  diminished  daily.  On 
the  8th  October,  when  our  patient  left  hospital,  the  wound  was  only 
two  and  a  half  to  two  and  three  quarters  inches  in  length — the  margins 
a  little  swollen,  the  suppuration  almost  entirely  ceased.  By  compara- 
tive examination  of  the  upper  inguinal  regions  one  simply  detected 
the  persistence  opposite  the  inguinal  ring  of  a  narrow  indurated  zone, 
and  a  rather  firm  condition  of  the  cord  for  a  distance  of  an  inch  or  two. 

After  castration  by  ordinary  methods  abscesses  sometimes  develop 
under  the  dartos.  Their  nature  is  well  known.  They  result  either 
from  too  early  union  of  one  of  the  operation  wounds — union  occurring 
while  suppurative  inflammation  is  still  going  on  in  subjacent  tissues  ; 
or  from  retention  of  a  foreign  body — one  of  the  strings  used  for 
fastening  together  the  branches  of  the  clams,  for  example.  But  deep- 
seated  abscesses  in  the  inguinal  space,  where  the  pus  remains  enclosed 
for  several  months,  as  in  the  case  just  mentioned,  are  exceedingly  rare. 

Apart  from  its  inherent  interest,  however,  this  case  teaches  a  lesson 
you  should  never  forget.  I  have  repeatedly  shown  you  that  in  wounds 
of  the  horse's  foot,  when  the  intensity  of  the  general  symptoms 
suggests  grave  local  mischief,  and  when  after  removing  the  horn  the 
subjacent  sensitive  tissues  appear  simply  to  be  inflamed  round  about 
the  wound,  it  is  necessary  to  incise  these  tissues,  and  to  seek  below 
them  the  principal  diseased  centre.  The  same  line  of  conduct  applies 
to  diseases  of  other  regions,  more  particularly  to  those  of  complex 
anatomical  structure.  When  the  local  lesions  met  with  in  superficial 
parts  do  not  sufficiently  explain  the  functional  and  general  disturbance 
which  have  led  to  surgical  interference,  you  must  seek  beyond,  and 
explore  the  depths.  With  exact  anatomical  knowledge,  prudent 
technique,  and  antiseptic  precautions,  exploration  of  these  regions  is 
unattended  with  danger. 


VIII.— DIAPHRAGMATIC    HERNIA. 

On  Thursday  last  a  horse,  which  had  suffered  from  cohc  for  nearly 
a  week,  and  whose  state  had  rapidly  become  aggravated  during  the 
last  night  passed  in  its  own  stable,  was  sent  here  for  advice.  At  the 
time  of  examination  it  was  in  a  very  grave  condition,  profoundly 
depressed,  and  staggering  on  its  legs.  The  face  was  drawn,  the  pulse 
almost  lost,  the  respiration  very  rapid  and  oppressed.  Percussion  of 
the  thorax  revealed  dulness  in  the  lower  third  and  tympanitic  reso- 
nance in  the  upper  parts.  On  auscultation  an  exaggerated  respirator}- 
murmur  was  heard  in  the  upper  third  of  both  sides  of  the  chest ; 
between  the  upper  and  middle  thirds  a  slight  deep-seated  tubal 
blowing  sound  ;  in  the  lower  parts  a  sound  indicating  the  presence  of 
liquid,  and  borborygmus.  The  heart-beats  were  very  feeble,  and  both 
jugulars  showed  a  venous  pulse. 

The  extreme  depression,  marked  pain,  irregularity  and  exaggeration 
of  the  flank  and  chest  movements,  and  especially  the  signs  furnished 
by  auscultation,  led  me  to  diagnose  diaphragmatic  hernia.  In  order 
to  confirm  this  diagnosis  I  washed  and  shaved  the  lower  half  of  the 
left  costal  region,  and  was  preparing  to  puncture  the  chest  with 
Dieulafoy's  aspirator,  when  the  animal  suddenly  fell,  and  died  after  a 
slight  struggle. 

The  post-uiortem  examination  confirmed  the  diagnosis  just  made. 
We  found  an  old-standing  diaphragmatic  hernia  with  a  very  large 
rupture  and  extensive  injury.  Many  of  you  were  absent  on  that  date, 
and  neither  saw  the  horse  nor  the  state  revealed  on  opening  the  body. 
As  this  is  a  very  rare  condition,  of  which  we  shall  probably  not  see 
another  case  during  the  course  of  this  year,  M.  Darras  will  read  to  you 
the  notes  which  he  made  : 

A  twelve-year  old  gelding  used  for  rapid  work. 

On  the  morning  of  the  nth  October  this  horse,  previously  in  good 
health,  showed  symptoms  of  colic.  He  appeared  anxious  and  restless, 
pawed  and  turned  his  head  towards  the  right  flank,  indicating  that  as 
the   seat    of  pain.     These   symptoms   disappeared   in   a   few   hours,   to 


DIAPHRAGMATIC    HERNIA.  45 

return,  however,  during  the  night  between  the  i6th  and  17th  October. 
The  animal  rolled  and  struggled  in  violent  pain.  On  the  morning  of 
the  17th,  having  refused  his  food,  he  was  sent  to  the  college.  He 
arrived  there  covered  with  sweat,  greatly  depressed,  and  looking  con- 
tinually towards  his  right  flank.  The  face  was  drawn,  the  nostrils 
dilated,  the  extremities  and  ears  cold,  the  mucous  membrane  cyanotic  ; 
the  respiration  was  32,  irregular  ;  the  pulse  very  feeble,  and  could  not 
be  counted  ;  the  jugulars  showed  a  well-marked  venous  pulse. 

Rectal  exploration  disclosed  nothing  abnormal.  On  the  catheter 
being  passed,  only  a  small  quantity  of  urine  was  drawn  off. 

On  percussion  of  the  chest  dulness  was  noted  in  the  inferior  half  of 
both  sides.  On  auscultation  the  vesicular  murmur  in  the  upper  portions 
of  both  pulmonary  lobes  was  exaggerated.  Towards  the  middle  region, 
especially  on  the  left  side,  a  slight  tubular  wheezing  sound  was  heard, 
and  in  the  lower  third  a  liquid  sound,  especially  marked  on  the  left 
side.  We  at  first  regarded  the  case  as  one  of  pericarditis,  but,  after 
carefully  examining  the  patient,  M.  Cadiot  noted  the  splashing  sound 
and  borbor\gmus,  and  delivered  the  diagnosis  of  diaphragmatic  hernia. 
To  confirm  the  diagnosis  he  resolved  to  tap  the  chest.  The  animal 
died  at  the  moment  we  were  about  to  perform  the  operation. 

Autopsy. — In  the  abdominal  ca\ity  traces  of  peritonitis  were  \isible 
on  the  large  colon,  jejunum,  and  ileum.  At  its  upper  part,  to\\ards  the 
left,  the  diaphragm  showed  a  large  opening,  through  which  had  passed 
a  considerable  mass  of  abdominal  ^'iscera,  comprising  among  other  parts 
the  stomach  and  some  loops  of  intestine.  These  viscera  were  soiled 
with  food  material. 

The  chest  cavity  contained  a  considerable  quantity  of  yellowish  acid- 
smelling  fluid,  holding  in  suspension  fragments  of  food.  The  left  lung, 
congested  in  its  antero-inferior  part,  and  emphysematous  throughout 
almost  its  entire  extent,  was  thrust  upwards  towards  the  spinal  column. 
The  spleen  was  situated  externally  and  posteriorly,  and  was  almost 
entirely  in  the  thorax.  It  appeared  normal.  Its  base  was  turned 
towards  the  abdomen  ;  its  point  was  advanced  and  slightly  depressed. 
Between  the  lung,  pericardium,  diaphragm,  spleen,  and  chest  walls,  was 
a  voluminous  greenish  mass  formed  by  the  gastro-colic  omentum  (epip- 
loon) filled  with  food.  Towards  the  back,  between  the  epiploic  sac, 
spleen,  and  diaphragm,  were  two  distinct  masses  of  intestine.  The 
first,  situated  above,  was  formed  by  a  part  of  the  small  colon,  about 
twelve  inches  in  length,  covered  by  the  epiploon  ;  the  other,  below, 
lodged  in  the  angle  formed  by  the  diaphragm  and  the  left  thoracic  wall, 
consisted  of  several  empty  loops  of  the  jejunum,  of  a  total  length  of 
about  fifteen  feet. 


46 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


More  deeply  situated  under  the  spleen  and  small  colon  we  found  the 
stomach,  flaccid  and  empt}-,  pushed  close  up  to  the  vertebral  column, 
the  right  half  in  advance,  the  smaller  curvature  turned  towards  the 
vertebral  column,  that  portion  of  the  left  sac  (fundus)  nearest  the 
oesophagus  riding  on  the  right  margin  of  the  rent  in  the  diaphragm,  a 
position  which  prevented  food  material  returning  into  the  oesophagus. 
The  cardiac  end  (fundus)  had  also  undergone  rotation,  which  prevented 
^•omiting.  In  the  greater  curvature  of  the  right  cul-de-sac  was  a  large 
rent  measuring  about  ele^•en  and  a  half  inches  in  length.     The  margins 


Fig.  6. — Diaphragmatic  hernia.      E,  epiploon.      I  G,  loop  of  small  intestine. 
C  F,  floating  colon.     R,  spleen.     P,  lung.     Pe,  pericardium. 


were  thin  and  blood-stained.  The  rent  extended  through  the  mucous 
membrane  for  a  length  of  ten  inches,  and  through  the  muscular  and 
serous  coats  a  further  four  inches.  The  two  latter  coats  were  retracted, 
forming  a  deep  red  margin  around  the  opening  in  the  mucous  membrane. 
From  this  opening  had  escaped  a  large  amount  of  food,  which  had  dis- 
tended the  large  epiploon. 

The  rupture  through  which  the  abdominal  viscera  had  entered  the 
chest  was  chiefly  situated  in  the  left  upper  portion  of  the  diaphragm. 
It  was  elliptical  in  shape,  and  measured  fourteen  and  a  half  by  six 
inches.  Its  margins  were  smooth  and  fibrous  throughout  the  greater 
part  of  their  length.  The  right  margin  was  straight,  thick,  and  rigid, 
and  ran  obliquel}'  from  aboxe  downwards  and  from  left  to  right.     Its 


DIAPHRAGMATIC    HERNIA.  47 

upper  extremity  was  situated  about  two  inches  from  the  cesophageal 
opening.  The  left  margin  was  concave  in  shape,  very  thick  above,  but 
thin  throughout  the  rest  of  its  extent,  and  was  everywhere  fibrous 
except  towards  its  centre,  where  it  appeared  injected  and  hasmorrhagic. 
At  the  centre  of  the  tear  was  a  strong  fibrous  band  as  thick  as  a  lead 
pencil. 

Through  this  large  opening,  which  had  certainly  existed  for  several 
months,  the  stomach  and  spleen  had  been  thrust  into  the  chest  cavity, 
describing  a  rotary  movement  forwards,  and  from  left  to  right,  around 
the  cardiac  end  of  the  stomach  as  an  axis,  causing  the  right  cul-de-sac 
of  the  stomach  (pxlorus)  to  advance  a  considerable  distance  into  the 
thorax. 

The  right  lung,  congested  and  emph}sematous  like  the  left,  was 
adherent  at  its  posterior  part  to  the  sides  of  the  chest.  Here  again  we 
found  food  material,  which  had  traversed  the  posterior  mediastinum. 
Of  this  mediastinum  only  traces  remained.  The  pericardium  contained 
about  a  quart  of  greyish  liquid. 

The  diaphragmatic  rupture  had  existed  for  a  long  time  ;  the  fibrous 
state  of  its  borders  showed  this  clearl}-.  The  hernia,  at  first  formed  of 
a  few  loops  of  small  intestine  and  epiploon,  had  scarcely  inconvenienced 
the  animal,  for  the  first  symptoms  of  colic  were  only  noted  six  days' 
before  death.  Gastric  indigestion  probabl}-  formed  the  first  step 
towards  producing  the  grave  symptoms  which  preceded  the  end.  The 
gastric  hernia  was  probably  produced  by  the  animal's  violent  struggles 
on  the  night  between  the  i6th  and  17th  October.  In  the  position  the 
stomach  had  assumed  food  could  no  longer  enter  it,  the  cesophageal 
opening  being  hermeticall}-  closed. 

To  sum  up,  this  horse  died  from  rupture  of  the  stomach,  a  compli- 
cation of  the  hernia  from  which  it  had  already  long  suffered,  as  shown 
by  the  state  of  the  walls  of  the  diaphragmatic  rent.  The  stomach 
was  probably  ruptured  soon  after  it  became  herniated. 

How  may  such  a  hernia  occur  ?  What  is  the  primary  cause  of  the 
diaphragm  becoming  ruptured  ? 

Cases  published  during  the  course  of  the  last  half-century  afford  a 
reply  to  these  questions.  In  these  the  accident  has  happened  in 
consequence  of  violent  struggles  and  energetic  contraction  of  the 
abdominal  muscles — either  during  work,  or  when  animals  had  been 
cast.  In  some  the  horse  was  heavily  laden,  and  after  a  specially  great 
effort  suddenl}'  stopped,  showed  pain,  fell,  and  died  from  asphyxia  ;  or 
again  survi^'ed  for  a  few  hours,  showing  s\-mptom3  cl  colic  and  severe 
dyspnoea.  Sometimes  an  animal  cast  for  operation,  after  struggling 
violently,  presented  the  same  alarming  symptoms  and  died  rapidly,  or 


48  CLINICAL    VETERINARY    :MEDICINE    AND    SURGERY. 

after  the  lapse  of  a  few  days.  In  either  case  post-mortem  examination 
showed  rupture  of  the  diaphragm,  usually  in  the  tendinous  portion  ;  a 
recent  extensive  rupture  with  bleeding  margins,  through  which  the 
abdominal  viscera  had  entered  the  chest.  Contraction  of  the  abdo- 
minal muscles  had  thrust  the  viscera  violently  against  the  diaphragm, 
overcoming  its  resistance.  Overloading  of  the  intestines,  and  of  the 
stomach  in  particular,  favours  rupture.  Chronic  hernise,  consequent 
on  extensive  ruptures  in  the  central  portion  of  the  diaphragm,  are 
produced  by  the  same  mechanism,  but  in  this  variety  the  primary 
symptoms  gradually  diminish,  and  the  lesions,  though  never  repaired, 
do  not  necessarily  prove  fatal. 

Injuries  to  the  costal  region  opposite  the  insertion  of  the  diaphragm, 
and  fracture  of  the  last  ribs,  are  also  fairly  frequent  causes  of  diaphrag- 
matic hernia.  In  these  cases  the  opening  is  often  of  small  dimensions, 
and  in  the  peripheral  (muscular)  portion  of  the  septum.  In  fracture 
of  one  or  several  ribs,  resulting  from  a  fall,  or  from  the  violent  impact 
of  a  comparatively  soft  body,  the  skin  may  not  be  penetrated,  or  may 
only  be  excoriated,  while  the  extremities  of  the  bones,  being  violently 
thrust  back,  rupture  the  muscular  zone  of  the  diaphragm  at  some 
point,  producing  a  rent  through  which  one  of  the  abdominal  organs 
may  enter  the  thorax.  As  a  rule,  hernia  soon  follows  the  rupture.  It 
may,  however,  be  postponed  to  a  later  period,  when  the  borders  of  the 
wound  have  to  some  extent  cicatrised, — the  rent,  however,  remaining 
patent.  Passage  of  abdominal  organs  into  the  thorax  through  one  of 
the  normal  openings  in  the  diaphragm  is  somewhat  rare — it  could 
scarcely  occur  except  after  dilatation  of  the  oesophageal  foramen. 
Congenital  hernia  need  only  be  mentioned — it  is  still  rarer  than  the 
preceding.  In  this  case  the  opening  in  the  diaphragm  results  from 
arrest  in  development. 

In  these  various  forms  of  diaphragmatic  hernia,  intestine  and 
epiploon  are  the  structures  oftenest  found  in  the  thorax.  A  narrow 
slit  is  sufficient  to  allow  of  their  passage.  Displacement  of  the 
stomach  and  spleen,  of  the  small  colon,  of  a  part  of  the  liver,  or  of  one 
of  the  flexures  of  the  large  colon,  is  less  common,  and  only  occur 
when  the  opening  is  of  very  large  dimensions,  as  in  our  case,  in  which 
the  stomach,  spleen,  the  greater  part  of  the  epiploon,  a  long  loop  of 
small  intestine,  and  a  loop  of  the  small  colon  had  entered  the  chest. 
However  small  the  diaphragmatic  rent,  several  organs  may  pass  through 
it.  The  position  they  assume  varies  :  for  instance,  a  loop  of  small 
intestine  and  a  portion  of  epiploon  may  become  lodged  between  the 
two  pulmonary  lobes  ;  considerable  masses  of  the  same  organs,  or  of 


DIAPHRAGMATIC    HERNIA.  49 

the  small  colon,  may  appear  on  the  floor  of  the  thorax  in  either  of  the 
pleuritic  cavities,  — oftenest,  however,  in  both,  the  resistance  of  the 
posterior  mediastinum  being  very  rapidly  overcome. 

Whatever  the  variety  of  hernia,  a  hernial  sac  is  never  seen  ;  the 
displaced  organs  are  directly  in  contact  with  the  pleura,  and  in  herniae 
of  long  standing  adhesions  usually  occur  between  the  organs  and  the 
costal,  pulmonary,  or  mediastinal  pleura.  The  pleural  and  peritoneal 
sacs  may  contain  a  certain  quantity  of  serosity,  but  abundant  exudate 
is  rare,  save  after  complications  due  to  engorgement  or  strangula- 
tion. 

The  dimensions  and  shape  of  the  diaphragmatic  opening  vary 
greatly.  In  recent  hernia  the  margins  are  red,  ecchymosed,  and  in- 
flamed ;  in  those  of  long  standing  thickened,  more  or  less  fibrous,  and 
less  vascular. 

The  gravity  and  character  of  the  symptoms  depend  greatly  on 
whether  the  condition  is  recent  or  of  old  standing,  and  on  the  volume 
of  the  organs  which  have  entered  the  thorax. 

Recent  large  hernia;  produce  violent  colic.  The  animal  then  exhibits 
an  anxious  look,  the  eyes  are  widely  opened,  the  nostrils  extremely 
dilated ;  the  respiration  is  markedly  difficult,  irregular,  and  jerky. 
When  the  volume  of  the  hernia  is  small  the  symptoms  are  much  less 
alarming  and  significant,  consisting  chiefly  in  depression,  failure  of 
appetite,  and  slight  colic.  The  breathing  shows  little  change,  though 
as  a  rule  it  is  short,  and  expiration  is  double. 

Large  chronic  hernia;  are  accompanied  b}-  irregularity  of  the  pulse. 
During  work  the  animals  soon  become  exhausted  and  "blow."  It  has 
been  noticed  that  animals  with  unilateral  herniae  always  lie  down  on 
the  same  side  as  the  hernia.  If  the  herniated  parts  are  of  small  size 
there  may  be  no  readily  appreciable  symptoms  so  long  as  the  digested 
material  and  the  blood  circulate  freely,  and  the  animal  may  continue 
to  do  ordinary  work  for  a  long  time  without  showing  serious  dis- 
turbance. A  number  of  cases  show  this.  Engorgement  and  strangu- 
lation, however,  readily  occur  in  such  concealed  hernia;,  because  the 
diaphragmatic  opening  is  almost  always  of  small  dimensions.  Com- 
plications of  this  kind  are  possible  in  all  old-standing  cases,  and  are 
announced  by  the  same  symptoms  as  obstruction  ("  stoppage")  of  the 
bowel. 

The  first  series  of  symptoms  produced  by  diaphragmatic  hernia 
may  be  summed  up  as  follows  : — colic,  great  anxiety,  dyspnoea,  irre- 
gularity, jerkiness,  and  doubling  of  the  expiratory  movement. 

When    hernia  is  suspected,    auscultation    and    percussion   greath' 

D 


^O  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

assist  diagnosis,  provided  a  considerable  portion  of  the  intestine  or 
stomach  has  passed  into  the  chest  cavity.  By  applying  the  ear  to  the 
lower  portions  of  the  chest  borborygmus  and  liquid  sounds  may  both 
be  very  clearly  heard  ;  sometimes  they  are  so  strong  as  to  give  the 
impression  of  proceeding  from  portions  of  the  intestine  close  to  the 
thoracic  wall,  or  directly  under  the  region  auscultated.  I  should 
remind  you  that  similar  but  duller  and  more  distant  abdominal  sounds 
may  be  heard  during  acute  affections  of  the  chest,  when  pleuritic 
effusion  or  pulmonary  hepatisation  exists. 

Over  the  remainder  of  the  chest  one  usually  notes  an  increased 
vesicular  murmur,  and  sometimes,  towards  the  middle  or  lower  third, 
a  slight  tubal  sound. 

Percussion  of  the  lower  part  of  the  thorax  reveals  a  zone  of  semi- 
dulness,  with  or  without  a  tympanitic  sound.  In  the  upper  parts 
resonance  is  normal.  In  recent  or  complicated  hernia  percussion  may 
produce  pain,  indicated  by  groaning,  or  by  the  animal  flinching  from 
the  operator. 

When  the  indications  furnished  by  auscultation  and  percussion 
are  not  sufficiently  characteristic  to  assure  the  diagnosis,  you  have  in 
exploratory  puncture  a  last  means  of  settling  the  question — I  should 
say,  which  may  settle  the  question, — for  when  the  trocar  or  needle 
fails  to  bring  away  fluid  from  the  stomach  or  intestine,  it  is  sometimes 
because  the  instrument  has  not  entered  the  viscus,  despite  the  latter 
being  displaced ;  while  should  the  hernia  consist  of  epiploon  or  spleen 
the  result  is  necessarily  negative. 

Although  diagnosis  is  possible,  you  see  that  in  cases  it  is  extremely 
difficult,  and  should  be  announced  with  the  greatest  reserve.  In  our 
patient  the  borborygmus  and  "  glou-glou  "  sound  extended  far  in 
advance,  and  were  unmistakable;  the  puncture,  which  I  suggested 
making,  would  have  dissipated  any  final  doubt.  On  passing  the 
trocar  we  should  have  seen  issue  a  little  greyish  liquid,  mixed  with 
fragments  of  semi-digested  material,  which  had  passed  into  the  two 
pleural  cavities  from  the  rupture  in  the  stomach. 

The  prognosis  is  in  the  highest  degree  grave.  Large  herniae  kill 
in  some  days,  often  even  in  a  few  hours  ;  sometimes  even  more  rapidly. 
Death  may  result  almost  instantaneously.  When  the  accident  occurs 
during  work  the  animal  becomes  greatly  depressed,  groans,  reels  about, 
falls  to  the  ground,  and  dies.  The  greater  number  of  herniae  compatible 
with  life  sooner  or  later  become  complicated — with  fatal  results  usually 
through   strangulation  and  gangrene  of  the  herniated  organs,  some- 


DIAPHRAGMATIC    HERNIA.  5  I 

times  through  rupture  of  the  intestine  or  stomach,  as  in  the  case  we 
have  seen.  Prognosis  is  rendered  still  graver  by  the  uselessness  of 
treatment. 

In  few  conditions  is  there  such  a  poverty  of  treatment.  The 
methods  suggested  are  either  ineffective,  dangerous,  or  impracticable. 
Let  us  shortly  consider  them. 

The  hernia  is  diagnosed,  and  is  recent.  It  has  existed  for  several 
days,  or  a  day,  or  for  only  a  few  hours.  What  are  we  to  do  ?  Some 
authors  recommend  the  treatment  usual  in  colic,  particularly  bleed- 
ing. It  is  better  to  leave  the  animal  quiet,  to  calm  pain  by  morphine 
or  chloral,  and  to  give  liquid  nourishment — gruel,  mashes,  or  milk. 
Provided  the  herniated  mass  is  not  too  large,  and  the  dimensions  and 
shape  of  the  rupture  do  not  favour  strangulation  by  engorgement,  the 
animal  may,  after  the  subsidence  of  inflammatory  symptoms,  become 
capable  of  light  steady  work.     Many  reported  cases  show  this. 

When  strangulation  has  occurred,  death  can  only  be  prevented  by 
surgical  intervention,  consisting  in  returning  the  herniated  organs  to 
the  abdominal  cavity.  Bouley  proposed  this  method.  As,  he  says, 
in  such  cases  death  is  certain,  why  not  try  the  only  possible  method 
of  avoiding  it  ?  This  consists  in  introducing  the  hand  into  the  abdo- 
men through  the  left  flank,  and  by  gently  pulling  on  the  displaced 
viscera  effecting  reduction.  Such  interference,  however,  would  be 
only  palliative.  The  rent  in  the  diaphragm  remaining  open,  the  hernia 
might  at  any  moment  recur  with  fatal  consequences.  As  to  radical 
cure,  /.  e.  reduction  of  the  hernia  and  closure  of  the  diaphragmatic 
wound,  it  has  hitherto  been  regarded  as  impracticable  in  large  animals. 


IX.— BLENNORRHOEA    IN    THE    DOG. 

In  dogs  brought  to  the  cHnique,  and  in  those  treated  for  varying 
diseases  in  our  infirmary,  you  have  often  noticed  a  discharge  from  the 
prepuce  which  at  first  sight  seems  to  present  a  distinct  analogy  with 
the  discharge  of  blennorrhoea  in  man.  Among  the  twenty-five  dogs  at 
this  moment  in  my  portion  of  the  hospital  eight  are  affected,  and  at  all 
times  of  the  year  you  will  find  a  somewhat  similar  proportion.  The 
condition,  therefore,  is  very  common.  It  will  form  the  subject  of  my 
lecture  to-day. 

This  disease  has  been  termed  blennorrhoea  and  gonorrhoea.  The 
first  title,  under  which  Renault  mentions  it  in  the  Recueil  of  1834,  is  the 
more  appropriate,  because  it  does  not  in  any  way  prejudge  the  nature  of 
the  affection.  That  of  gonorrhoea  has  the  disadvantage  of  suggesting  an 
analogy  between  this  discharge  and  that  of  the  same  named  condition 
in  man.  The  term  "  echauffement  "  is  wrong,  for  the  discharge  may 
appear  in  animals  of  very  phlegmatic  temperament,  without  having 
been  produced  by  violent  sexual  excitement  or  by  repeated  sexual 
intercourse. 

Almost  always  localised  in  the  mucous  membrane  lining  the  prepuce 
and  covering  the  base  of  the  penis,  the  common  form  of  this  affection 
consists  in  a  chronic  catarrh  which  even  at  the  outset  is  very  rarely 
accompanied  by  appreciable  inflammatory  symptoms.  Some  writers 
aver  that  the  disease  is  always  limited  to  the  lining  membrane  of  the 
sheath,  but  in  point  of  fact  that  of  the  penis  is  also  affected,  particu- 
larlv  about  and  behind  the  corona  glandis. 

The  catarrh  produces  a  more  or  less  abundant  though  usually 
trifling  muco-purulent  secretion,  which  exudes  from  the  orifice  of  the 
sheath,  gluing  together  the  hairs  surrounding  this  point.  Except 
when  the  animal  has  just  urinated,  and  especially  in  the  morning,  these 
hairs  are  soiled  with  a  greenish,  greyish,  or  yellowish-white  muco-pus, 
viscous  in  character,  sometimes  fairly  thick,  sometimes  serous,  which, 
by  drying,  may  form  little  crusts  fixed  to  the  base  of  the  hairs,  and 
covering  the  parts  surrounding  the  preputial  opening.     The  amount  of 


BLENNORRHCEA    IN    THE    DOG.  "  53 

secretion  may  be  estimated  by  slightly  pressing  with  the  fingers  along 
the  course  of  the  sheath  from  behind  forwards.  The  greater  portion 
of  the  muco-pus  contained  within  the  cavity  of  the  sheath  is  thus 
expelled.  When  protruded,  the  penis  is  seen  to  be  covered  with  this 
muco-pus,  some  of  which  may  easily  be  collected  on  the  flattened  end 
of  a  director. 

Very  rarely  indeed  is  the  mucous  membrane  of  the  urethra  affected. 
One  may  carefully  manipulate  the  whole  course  of  the  exposed  portion 
of  the  penis  and  of  its  inferior  border  (where  the  urethra  is  situated) 
without  causing  the  smallest  droplet  of  pus  to  exude.  Urine  is  easily 
and  painlessly  voided,  showing  that  the  mucous  membrane  of  the 
urethra  is  unaffected.  But  although  in  blennorrhoea  in  the  dog  the 
urethra  is  very  generally  healthy,  cases  are  occasionally  seen  where  the 
process  has  extended  to  the  entire  surface  of  the  penis,  and  to  a  short 
portion  of  the  urethra.  Methodical  compression  from  behind  forwards 
then  causes  the  discharge  of  a  little  greenish  muco-pus.  The  mucous 
membrane  covering  the  penis  and  prepuce  may  be  at  first  a  little 
infected,  especially  behind  the  corona  glandis  and  the  cul-de-sac  ;  after- 
wards the  hypersemia  disappears,  and  the  membrane  resumes  its 
normal  appearance, — the  morbid  secretion,  however,  persisting.  In 
time  the  parts  may  show  small  granulations  of  lymphatic  origin, 
scarcely  exceeding  a  grain  of  millet  in  size.  When  the  mucous  mem- 
brane is  thus  changed,  pressure  over  it  is  always  a  little  painful. 

There  are  neither  general  nor  local  complications  beyond  the 
genital  organs.  The  disorder  produces  no  febrile  symptoms,  at  least 
at  first.  One  simply  notes  that  the  majority  of  animals,  when  lying 
down,  appear  to  suffer  from  an  itching  sensation  which  causes  them  to 
lick  the  base  of  the  sheath. 

Blennorrhoea  occurs  under  varying  circumstances,  and  from  many 
different  causes.  Very  frequent  in  young  animals,  it  appears  usually 
during  distemper,  and  is  especially  common  in  dogs,  which  show 
exanthematous  outbreaks  on  the  belly.  At  all  ages  it  may  accompany 
eruptive  disorders.  It  is  often  seen  in  animals  suffering  from  acute 
or  chronic  parasitic  or  dyscrasic  diseases  of  the  skin.  It  affects  even 
the  best  nourished  during  the  course  of  eczematous  eruptions,  a  fact 
which  has  caused  some  to  regard  it  as  due  to  gout.  Others  have 
referred  it  to  repeated  coitus,  especially  between  large  males  and  small 
females.  For  a  long  time  it  was  regarded  as  contagious,  but  this  has 
not  been  proved  either  by  clinical  observations  or  by  experiment. 
Renault  and  Delafond  in  vain  tried  to  communicate  the  disease  from 
dog  to  dog.  They  collected  some  of  the  muco-pus  and  deposited  it  on 
the  mucous  membrane  of  the  prepuce  or  penis.     They  even  made  sure 


54  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY, 

of  its  penetrating  by  infriction  or  inoculation,  but  always  with  the 
same  negative  result. 

I  have  repeatedly  attempted  to  transmit  blennorrhoea  to  males  and 
females,  but  whether  the  pus  was  placed  at  the  entrance  of  the  sheath 
and  on  the  penis,  or  in  the  vulvo-vaginal  cavit)',  whether  it  was  simply 
spread  on  the  mucous  membrane  by  rubbing,  or  by  pressure  on  the 
preputial  sheath,  or  lips  of  the  vulva,  the  attempts  always  failed.  Nor 
was  I  more  successful  when  applying  it  to  the  eye  or  conjunctival 
mucous  membrane.  Nevertheless,  and  despite  the  fact  that  the  condi- 
tion is  rare  in  the  bitch,  I  did  not  conclude  from  these  experimental 
results  that  it  is  never  transmitted  during  the  sexual  act.  Under 
favourable  circumstances,  at  present  unrecognised,  the  exudate  cover- 
ing the  penis  may  probably  become  virulent  and  infective. 

Bacteriological  examination  of  this  exudate  reveals  the  presence  of 
numbers  of  common  microbes,  especially  isolated  micrococci,  strepto- 
cocci, and  sometimes  staphylococci  and  various  bacteria.  Soiling  of 
the  preputial  opening  when  the  dog  is  lying  down,  and  of  the  penis 
during  the  attempts  at  coitus  made  by  young  dogs,  readily  explains 
the  diversity  of  germs  found  in  the  exudate. 

The  duration  of  blennorrhoea  varies  greatly  according  to  the 
patient's  manner  of  life  and  the  care  bestowed  on  it.  In  young  pet 
dogs,  attacked  during  distemper,  it  is  generally  treated  and  disappears 
in  a  few  weeks.  In  neglected,  dirt}-,  and  badly  fed  animals  it  may 
persist  for  months,  even  for  years,  the  discharge  increasing  or  dimin- 
ishing from  time  to  time.  Though  usually  easy  to  cure  when  recent, 
it  in  time  becomes  obstinate,  and  can  onl}-  be  dealt  with  by  steady, 
long-continued  treatment. 

Apart  from  this  benign  form  of  blennorrhcea,  the  dog  occasionall)- 
suffers  from  acute  inflammation  of  the  mucous  membrane  of  the  pre- 
puce and  penis,  which  sometimes  extends  to  the  first  portion  of  the 
urethra,  and  is  accompanied  by  an  abundant  greyish-green  discharge, 
marked  itching,  and  pain  during  micturition.  When  lying  down  the 
subject  continually  licks  the  sheath,  which  is  more  or  less  hot  and 
swollen.  Left  to  itself  this  disease  may  become  complicated  with  in- 
flammation of  the  inguinal  glands  and  diffuse  inflammation  of  the  pre- 
puce. In  common  with  Siedamgrotzky  and  Moller,  I  have  seen  such 
cases.  I  believe  this  variety  of  blennorrhcea  and  its  complications  are 
due  to  one  of  the  micro-organisms  found  in  the  former  condition,  the 
virulence  of  which,  however,  has  increased.  In  pus  from  an  abscess  of 
the  sheath  I  found  streptococci  in  short  chains. 

The  diagnosis  of  blennorrhoea  in  the  dog,  whether  acute  or  chronic, 
offers  no  difficulty.     In  those  extremely  rare  cases  where  the  terminal 


liLENNORRHCEA    IN    THE    DOG.  55 

portion  of  the  urethra  is  affected,  examination  of  the  urine  voided 
towards  the  end  of  the  act  of  micturition  enables  the  disease  to  be 
distinguished  from  affections  of  the  genito-urinary  organs  proper. 
Polypi  developed  on  the  penis,  or  lining  membrane  of  the  prepuce, 
give  rise  to  a  sanguinolent  discharge,  and  as  a  rule  produce  knobby 
swellings  of  the  sheath.  Even  when  of  small  size,  or  deeply  situated, 
they  can  immediately  be  diagnosed  by  exposing  the  base  of  the  penis 
and  drawing  back  the  sheath.  I  should  remind  you  of  the  occurrence 
of  traumatic  blennorrhoea,  caused  by  the  accidental  entry  into  the 
sheath  of  some  foreign  body  like  a  fragment  of  straws  a  thorn,  a  husk  of 
grain,  a  little  fragment  of  wood,  or  more  rarely  by  a  ligature,  which 
some  mischievous  person  or  child  has  applied  to  the  penis. 

Local  applications  are  used  in  all  cases,  but  in  some  varieties  of  the 
disease  constitutional  treatment  appropriate  to  the  general  condition  of 
the  patient  is  also  necessary. 

The  sheath  is  cleansed  and  disinfected  by  syringing  out,  for  some 
days  in  succession,  with  warm  boric  solution.  This  is  retained  by 
closing  the  preputial  orifice  with  the  finger,  and  any  fragments  of  mucus 
adherent  to  the  lining  membrane  are  removed  by  gently  massaging  the 
parts  for  a  few  moments  before  the  liquid  is  allowed  to  escape.  Boric 
acid  is  afterwards  replaced  by  a  'i  or  '05  per  cent,  sublimate,  by  i  per 
cent,  sulphate  or  chloride  of  zinc,  or  by  2  to  3  per  cent,  alum  or  tannin 
solution.  Injections  need  only  be  made  once  a  day,  or  even  once  every 
two  days.  If  the  discharge  diminishes  rapidly  the  injections  should 
still  be  continued  for  a  time,  as  when  it  disappears  too  soon  it  is  apt 
to  return  ;  a  drop  of  muco-pus  is  seen  one  morning  at  the  opening  of 
the  sheath,  and  each  succeeding  day  increases.  The  i  or  2  per  cent, 
solution  of  nitrate  of  silver  is  rarely  necessary,  even  in  old-standing 
cases,  the  i  per  cent,  solution  of  sublimate  or  chloride  of  zinc  being 
preferable. 

In  the  acute  form  of  blennorrhoea  the  same  treatment  with  boric  or 
sublimate  injections  is  indicated.  In  addition,  a  moist  antiseptic  com- 
press is  applied  to  the  sheath,  and  retained  in  position  with  a  bandage. 

For  distemper  or  other  complications  young  dogs  often  require  in- 
ternal medication.  According  to  their  age,  temperament,  and  bodily 
condition,  adults  are  treated  with  alkalies,  arsenical  preparations,  iodide 
of  potassium,  or  iodide  of  iron. 


X.— AMPUTATION  OF  THE  PENIS  IN  THE  HORSE. 

Some  days  ago  a  horse  was  sent  here,  on  which  I  at  once  performed 
ablation  of  the  penis.  I  take  advantage  of  this  case  to  recapitulate  the 
particulars  of  operation,  to  examine  the  various  available  methods  of 
performing  it,  and  to  indicate  that  which  I  prefer. 

As  a  general  rule,  grave  disorders  of  the  penis  are  distinctly  rare  in 
the  horse.  We  see  little  else  but  tumours  and  paralysis,  still  wrongly 
described  under  the  old  name  of  paraphimosis. 

Epithelial  tumours — the  cancroids — almost  always  spring  from  the 
lower  portion  of  the  penis,  from  its  anterior  surface,  or  from  the  corona 
glandis.  They  commence  as  indurated  nodules,  which  more  or  less 
rapidly  extend  in  area  and  depth,  ulcerate,  and  discharge  a  greyish  pus 
streaked  with  blood.  Sometimes  the  ulcer  spreads  and  perforates  the 
glans,  whilst  the  penis  gradually  becomes  indurated ;  sometimes  the 
process  is  of  a  markedly  hypertrophic  character.  Exuberant  bleeding 
granulations  mask  the  ulcer,  suppuration  is  abundant,  haemorrhage 
occurs  from  time  to  time,  and  staling  may  become  difficult.  The  lower 
portion  of  the  penis  grows  dense,  hard,  and  painful,  forming  in  advance 
of  the  sheath  an  irregular  mass,  which  may  attain  the  size  of  a  child's 
head. 

Sarcomata  are  much  rarer  than  epitheliomata.  In  the  few  published 
cases  the  tumour  developed  towards  the  base  of  the  sheath,  and 
extended  to  the  penis. 

Apart  from  these  malignant  tumours  I  should  draw  attention  to 
verrucous  new  growths,  which  also  develop  on  the  free  extremity  of  the 
penis,  sometimes  become  of  large  size,  compress  the  urethra,  and  cause 
difficulty  in  staling,  or  even  retention  of  urine.  These  papillomata  have 
special  characteristics  by  which  they  may  be  distinguished  from  epithe- 
liomata and  sarcomata.  They  are  usually  multiple,  firm,  hard,  whitish, 
and  of  regular  consistency  throughout.  They  do  not  invade  the  sub- 
tegumental  tissues,  and  permanently  retain  their  early  characteristics 
without  becoming  ulcerated.  When  very  numerous  they  may  become 
confluent,  and,  by  the  enormous  development  of  their  connective-tissue 


AMPUTATION    OF    THE    PENIS    IN    THE    HORSE.  57 

basis,  form  fibrous  tumours  of  considerable  size.  The  transformation 
of  papillomata  into  cancroids  and  invading  new  growths  is  admitted 
by  some  authors,  and  seems  estabhshed  by  several  good  recorded  cases. 
They  can,  however,  usually  be  successfully  excised,  provided  the}-  are 
not  very  numerous,  or  when  in  difficult  positions  their  excision  is  not 
likely  to  be  followed  by  interference  with  micturition. 

Paralysis  of  the  penis  may  result  from  violent  local  contusions,  or 
from  injury  to  the  perinaeum.  Cases  occur  where  the  history  quite  fails 
to  explain  the  onset  of  the  condition,  and  paralysis  has  several  times 
been  seen  to  occur  suddenly  in  worn-out  horses.  It  is  oftenest  of 
secondary  character,  resulting  from  certain  infectious  diseases,  chief 
among  which  are  contagious  pneumonia  and  influenza.  Sometimes  it 
seems  to  have  followed  simple  attacks  of  colic. 

There  is  no  paraphimosis,  for  the  base  of  the  penis  is  in  no  way 
strangulated  by  the  sheath.  Furthermore  the  persistence  of  local 
sensation,  and  the  active  movements  still  noted  in  certain  cases,  show 
that  paralysis  seldom  becomes  complete. 

Anatomical  and  pathological  researches  undertaken  for  the  purpose 
of  clearing  up  the  nature  of  this  condition  have,  until  now,  only 
revealed  accessory  lesions  in  the  corpus  cavernosum,  subtegumental^ 
connective  tissue,  and  upper  venous  trunks.  The  corpus  cavernosum 
shows  considerable  thickening  of  the  fibrous  septa  bounding  the  alveoli 
through  which  the  blood  passes  from  the  arterial  ramifications  into  the 
vein.  This  change  is  especially  marked  in  the  lower  portion  of  the 
penis  ;  it  results  from  blood  stasis.  Free  serous  infiltration  into  the 
subcutaneous  connective  tissue  is  soon  followed  by  induration,  the  parts 
becoming  firm,  lardaceous,  and  difficult  to  cut.  The  chief  veins  traversing 
this  tissue  are  obliterated  by  old,  hard,  stratified  clots.  These  lesions 
still  leave  the  pathology  of  the  condition  obscure.  It  may  result  from 
disturbance  due  to  extravasations  of  blood  following  violence,  or  to 
haemorrhage,  or  to  phlebitis  occurring  during  some  infectious  disease, 
but  very  generally — like  the  majority  of  other  local  paralyses  resulting 
from  infection  (and  notably  from  contagious  pleuro-pneumonia) — it  is 
of  toxic  character,  due  to  a  lesion  of  the  medulla,  or  of  the  nerves  of 
the  penis. 

Whatever  its  nature  and  cause,  paralysis  of  the  penis,  once  produced, 
is  marked  by  objective  symptoms,  which  usually  become  aggra- 
vated in  time.     The  penis  appears  more  or  less  pendulous,  increases 

*  The  integument  covering  the  penis  is  intermediate  in  texture  between  skin  and  mucous 
membrane.  To  avoid  the  inconvenience  of  repeating  "  integument,"  etc. ,  at  frequent  intervals, 
I  have  taken  the  liberty  of  describing  it  as  skin. — Jno.  A.  W.  D. 


58  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

in  size,  and  becomes  covered  with  circular  ridges  and  depressions, 
which  either  extend  to  the  whole  organ  or  only  to  a  part.  Infil- 
tration of  the  subcutaneous  connective  tissue  slowly  advances.  This 
layer  and  the  skin  undergo  a  hardening  process,  the  folds  disappear, 
and  in  time  the  penis  may  become  five  to  ten  times  larger  than  normal. 
It  then  appears  as  a  heavy  cylindrical  mass  which  swings  about  during 
movement ;  its  upper  part  is  covered  by  the  exposed  and  distended  skin 
of  the  sheath,  between  which  and  the  scrotum  there  is  no  distinct  line  of 
delimitation.  When  animals  are  kept  in  this  condition  the  penis  is 
exposed  to  continual  irritation,  in  consequence  of  which,  and  also  of 
trophic  disturbance,  the  skin  ulcerates,  or  patches  become  gangrenous, 
particularly  about  the  lower  parts.  In  one  case  you  saw  on  the  glans 
penis  an  ulcer  as  large  as  a  two-shilling  piece,  produced  by  mortification, 
of  a  fragment  of  skin  ;  the  walls  of  this  ulcer  were  covered  with  old- 
standing  indolent  granulations. 

In  some  cases  paralysis  of  the  penis  becomes  cured  naturally ; 
infiltration  of  the  tissues  gradually  diminishes,  and  finally  disappears  ; 
but  much  more  frequently  it  persists  even  when  rationally  treated. 
The  chief  methods  resorted  to  consist  in  superficial  scarification,  or 
light  needle  firing,  douches,  stimulant  applications,  repeated  compression 
with  a  rubber  bandage,  and  electricity.  The  most  used  are  scarification, 
firing,  and  cold  water  treatment.  Ten  to  fifteen  narrow  perforations 
are  made  with  the  bistoury  or  cautery  around  the  swollen  mass.  If 
necessary,  haemorrhage  is  arrested  by  cold  applications  ;  on  the  following 
days  three  or  four  spray  douches  are  given,  lasting  for  five  to  ten  minutes. 
In  a  few  instances  you  have  seen  these  methods  succeed,  but  in  the 
greater  number  they  are  disappointing. 

Failing  improvement,  the  animals  may  be  worked  by  protecting  the 
penis  with  a  suspensory  bandage  or  a  leather  sheath  fixed  to  the 
breeching,  and  kept  in  position  by  one  or  more  straps  passed  over  the 
lumbar  region  ;  but  by  rubbing,  the  sheath  often  irritates  the  penis  and 
favours  the  production,  and  afterwards  the  extension,  of  injuries  like 
those  of  which  I  have  just  been  speaking. 

Where  paralysis  is  of  old  standing,  or  malignant  tumours  exist,  it  is 
necessary  to  amputate  the  penis. 

In  the  case  of  new  growths  excision,  to  give  lasting  results,  must  be 
performed  through  a  healthy  portion  of  the  penis,  a  little  above  the 
upper  margin  of  the  tumour.  When  operating  for  paralysis,  the  penis 
is  cut  through  between  the  middle  and  upper  thirds. 

The  different  operative  methods  are  as  follows  : 

Amputation  b}-  ligature  is  more  than  a  centur}'  old.    Huzard  used  it 


.    AMPUTATION    OF    THE    PENIS    IN    THE    HORSE.  59 

with  success  in  a  horse  with  enormous  papillomata  of  the  glans  penis. 
He  introduced  into  the  urethra  a  metalhc  tube,  perforated  near  its  free 
extremity  with  two  holes,  through  which  tapes  could  be  passed  and  tied 
over  the  loins,  lixing  the  tube  in  position.  Towards  the  centre  of  the 
penis  he  applied  a  loop  of  waxed  cord,  which  was  gradually  drawn  tight 
until,  about  the  eighth  day,  the  lower  portion  of  the  penis  became 
detached.     The  process  was  hastened  by  a  few  strokes  of  the  bistour3\ 

The  advantages  offered  by  elastic  cords  render  them  preferable  to  the 
old  forms  of  ligature.  A  tube  or  solid  cord,  of  size  proportionate  to  that 
of  the  penis,  is  chosen.  A  metallic  sound  having  been  introduced  into 
the  urethra,  one  end  of  the  cord  is  grasped  by  an  assistant  and  tightly 
stretched,  in  which  condition  it  is  passed  three  or  four  times  around  the 
penis  at  the  point  to  be  divided,  the  crossing  of  the  two  ends  being 
united  with  a  tightly  tied  piece  of  string.  The  ligature  continues  to 
contract  until  the  tissues  are  completely  divided.  If  at  first  well  applied, 
it  requires  no  supervision.  The  cord  gradually  cuts  the  tissues,  closing 
and  obliterating  the  vessels.  There  is  no  haemorrhage,  and  suppuration 
is  trifling.  In  a  case  related  by  Labat  division  was  complete  in  eleven 
days;  in  a  horse  operated  on  in  my  clinique  in  i88g  it  occurred  on  the 
ninth  day. 

Whatever  the  nature  of  the  material  employed,  section  proceeds 
very  slowly.  For  this  reason  more  rapid  though  still  bloodless  methods 
have  been  recommended. 

Direct  amputation  has  often  been  performed  with  a  sharp-edged 
firing  iron  at  a  white  heat.  The  operation  is  facilitated  by  introducing 
into  the  urethra  a  metallic  sound.  The  upper  and  lower  parts  of  the 
penis  are  covered  with  wet  cloths,  leaving  the  operation  area  exposed. 
An  assistant  grasps  the  free  extremity  of  the  penis,  exercising  moderate 
traction.  A  circular  line  is  first  traced  at  the  point  where  section  has 
to  be  performed,  and  the  tissues  are  gradually  cut  through  until  section 
is  complete.  A  series  of  irons  heated  to  the  proper  temperature  are 
generally  necessary.  M.  Nocard  has  used  the  galvanic  loop.  With 
this  instrument  operation  is  complete  in  about  ten  minutes.  Some 
practitioners  prefer  the  ecraseur  ;  by  cutting  sufficiently  slowly  the 
loss  of  blood  is  trifling.  The  corpus  cavernosum,  however,  offers  great 
resistance  to  the  chain,  and  sometimes  renders  it  necessary  to  finally 
resort  to  the  knife.  In  man}-  cases  the  chain  has  broken,  and  the 
operator  been  compelled  to  use  the  ligature.  M.  Trasbot  recommended 
introducing  a  director  into  the  urethra,  and  using  a  small  ecraseur,  the 
loop  of  which  is  passed  round  the  penis,  and  shortened  daily  by  means 
of  a  special  catch  engaging  with  the  chain. 

Simple  excision  with  the  bistoury  is  rapid  but  dangerous.     Abundant 


6o  CLINICAL    VETERINARY    .MEDICINE    AND    SURGERY. 

haemorrhage  may  occur,  even  when  the  principal  vessels  are  ligatured 
or  closed  by  forceps.  Barthelemy  used  this  method  in  a  horse  with 
paralysis  of  the  penis  following  influenza.  He  confined  himself  to 
amputation  pure  and  simple,  without  taking  any  haemostatic  precau- 
tions, without  tying  the  arteries  or  cauterising  the  stump.  During 
the  following  days  a  considerable  discharge  of  blood  occurred  when 
the  animal  staled.  In  all  a  large  quantity  was  lost,  "  fifty  pounds,"  it 
was  said,  but  nevertheless  the  horse  was  able  to  return  to  work  on  the 
tenth  day. 

Any  of  the  methods  of  operation  just  passed  in  review  may  involve 
a  grave  complication,  which  usually  appears  during  the  third  month 
after  recovery.  I  refer  to  contraction  of  the  lower  part  of  the  urethra. 
Contraction  of  the  cicatricial  tissue  developed  in  the  stump  first  reduces 
and  then  more  or  less  completely  closes  the  urethral  orifice.  This 
complication  is  especially  to  be  feared  when  the  penis  is  of  large  size 
at  the  point  where  amputation  is  practised,  /.  e.  in  cases  of  paralysis. 
As  soon  as  this  attains  a  certain  degree,  emission  of  urine  becomes 
difficult  ;  it  escapes  in  a  fine  intermittent  jet,  and  ends  by  being 
expelled  drop  by  drop.  Colicky  s}mptoms  then  appear,  and  if  relief 
is  not  afforded  the  animal  may  die  of  rupture  of  the  bladder.  The 
simplest  method  of  remedying  this  condition  is  to  introduce  into  the 
urethral  opening  the  points  of  a  pair  of  dressing  forceps,  or  of  strong 
artery  forceps,  and  while  opening  the  jaws  to  steadily  withdraw  the 
instrument.  The  cicatricial  tissue  is  thus  broken  down,  and  the 
orifice  for  the  time  being  rendered  patent ;  but  contraction  soon  recurs, 
and  with  it  the  same  difficulty  in  micturition.  A  new  operation 
becomes  necessary,  in  consequence  of  which  the  walls  of  the  urethra 
afterwards  become  indurated  for  a  greater  distance ;  finally  the  opera- 
tion becomes  insufiicient.  Perinaeal  urethrotomy  must  then  be  per- 
formed, or  the  animal  slaughtered. 

Contraction  of  the  urethra  may  be  avoided  by  one  of  the  two 
following  methods. 

The  first  consists  in  cutting  through  with  the  bistoury  or  thermo- 
cautery all  the  tissues  of  the  penis  except  the  urethra,  which,  after 
having  been  carefully  dissected  out,  is  divided  about  three  quarters  of 
an  inch  nearer  the  free  end.  This  kind  of  artificial  urethral  tube  is 
afterwards  divided  vertically  and  transversely,  so  as  to  form  four  flaps, 
each  of  which  is  fixed  to  the  amputated  surface  by  means  of  a  suture. 
In  the  other  method,  derived  from  human  surgery,  where  it  was  first 
practised  by  Richet  and  Ricord,  and  afterwards  skilfully  modified  by 
M.  Guyon,  a  reversed  V-shaped  incision  is  made  immediately  above 


AMPUTATION    OF    THE    PENIS    IN    THE    HORSE. 


6r 


the  line  of  amputation,  and  on  the  lower  surface  of  the  penis,  the  skin 
being  first  divided,  then  the  subjacent  tissues,  the  suspensory  ligaments, 
corpora  cavernosa,  and  erectile  tissue  ;  the  urethra  is  next  cut  through 
transversel}-,  opposite  the  base  of  the  \/,  its  inferior  surface  dissected 
free  from  all  the  exposed  tissues,  the  edges  of  which  are  afterwards 
sutured  to  those  of  the  cutaneous  wound  ;  lastly,  the  penis  is  cut 
through  opposite  the  point  where  the  urethra  was  divided,  and  the 
chief  vessels  closed  by  means  of  ligatures  or  forceps.  Or,  again,  a  pre- 
ferable method  so  far  as  checking  haemorrhage  is  concerned,  consists 
in  applying  an  elastic  ligature  opposite  the  base  of  the  wound,  and 
amputating  the  penis  an  inch  or  so  below. 

At  the  present  time  I  employ  this  latter  method  exclusively.  The 
procedure  is  as  follows  : 

The  animal  having  been  cast  on  the  left  side,  the  right  hind  limb 


Fig.  7. — Amputation  of  the  penis. 

IS  lifted,  carried  forward,  and  iixed  to  the  corresponding  forearm,  as  in 
castration  ;  the  penis  is  disinfected,  together  with  the  posterior  abdo- 
minal and  scrotal  regions. 

Having  introduced  a  catheter  into  the  urethra  for  a  distance  of  ten 
to  twelve  inches,  an  assistant  covers  the  free  portion  of  the  penis  with 
a  cloth,  and  draws  it  gently  forwards.  Another  assistant,  placed  behind 
the  patient,  draws  the  skin  covering  the  base  of  the  penis  towards  the 
perinaeum.     A  ligature  is  then  applied  to  the  base  of  the  penis. 

A  little  above  the  point  where  I  intend  to  amputate  I  trace  on  the 
inferior  surface  of  the  organ  two  lines,  starting  from  above  the  urethra 
and  diverging  towards  their  free  ends  (an  inverted  V  in  fact),  the 
extremities    being  about    i]   to   i^  inches  apart.     The  base  of  these 


62  CLINICAL    VETERINARY    INIEDICINE    AND    SURGERY. 

incisions  is  united  by  a  transverse  incision,  and  the  triangle  of  skin 
thus  dehmited  is  removed.  I  then  excise  the  subjacent  tissues,  layer 
by  layer,  over  the  space  covered  by  this  wound  until  the  urethra  is 
exposed.  This  is  opened  at  the  lower  margin  of  the  wound  by  a 
transverse  section.  I  then  remove  the  catheter,  and  pass  a  grooved 
director  into  the  exposed  end  of  the  divided  urethra,  the  groove  being 
directed  towards  the  lower  surface  of  the  tube,  and  with  the  bistoury 
I  divide  the  urethra  along  its  middle  line  throughout  the  entire  length 
of  the  part  exposed.  I  then  divide  it  transversely,  and  afterwards 
unite  each  flap  of  the  mucous  membrane  of  the  urethra  to  the  corre- 
sponding flap  of  the  skin  of  the  penis  by  silk  sutures  I  complete  the 
operation  by  applying,  just  at  the  base  of  the  wound,  four  or  five  turns 
of  a  tightly  stretched  rubber  cord.  The  ends  of  the  cord  are  fastened 
together,  and  the  penis  divided  an  inch  or  so  below  with  a  single  cut. 

For  several  years  before  adopting  the  above  method  of  preparing 
the  urethral  orifice  I  was  in  the  habit  of  dividing  the  penis  with  a 
bistoury,  and  closing  the  principal  arteries  by  ligatures,  or  by  applying 
forceps.  Abundant  attacks  of  haemorrhage  used  then  to  occur  during 
several  days,  under  the  influence  of  the  semi-erections  which  marked 
the  moment  of  staling. 

With  the  method  referred  to  a  mass  of  dead  tissue  remains  for 
several  days  adherent  to  the  end  of  the  penis.  Any  risk  of  infection  is 
prevented  by  antiseptic  irrigations.  The  dead  mass  and  ligature  fall 
away  between  the  sixth  and  tenth  days.  The  stump  is  then  usually 
much  tumefied,  but  the  swelling  and  oedema  rapidly  diminish.  The 
wound  suppurates  little.  A  layer  of  granulations  soon  covers  it,  becomes 
hard,  and  contracts,  gradually  drawing  the  skin  over  the  stump  until 
towards  the  end  of  the  third  month  ;  the  cicatrix  is  comparatively 
small.  As  for  the  muco-cutaneous  wound,  when  the  sutures  hold,  and 
the  mucous  membrane  does  not  cut  through,  the  apposed  lips  rapidly 
unite.  Most  frequently,  however,  the  mucous  membrane  cuts  through 
at  one  or  more  points  and  becomes  separated  from  the  skin  ;  vegetations 
occur  on  the  exposed  tissues,  often  becoming  so  abundant  as  partially 
to  obstruct  the  meatus.  There  is,  however,  no  cause  for  alarm.  Ex- 
cessive granulation  soon  ceases,  the  parts  heal ;  like  the  wound  on 
the  extremity  of  the  penis,  cicatricial  contraction  results  in  drawing 
the  mucous  membrane  towards  the  skin,  and  the  urethral  opening 
resumes  and  permanently  preserves  the  shape  given  to  it  by  the 
operator.  In  both  cases  the  final  result  is  the  same;  when  the  surgeon 
has  done  his  part  well,  patency  of  the  urethral  opening  is  ensured. 
As  soon  as  inflammatory  symptoms  disappear,  the  animal  stales  with 
the  same  ease  as  any  other  horse. 


AMPUTATION    OF    THE    PENIS    IN    THE    HORSE.  63 

Of  five  cases  operated  on  in  my  clinique,  during  a  period  of  two 
years,  not  one  has  shown  after-contraction ;  and  in  those  treated  be- 
tween 1890  and  1895  the  results — except  for  haemorrhage — have  been 
not  less  satisfactory. 

Should  you  have  to  remove  the  penis  in  the  horse,  do  not  hesitate 
to  adopt  the  operation  you  have  seen  me  perform  ;  though  it  demands 
a  little  more  time  and  care  than  other  methods,  its  superiority  is 
beyond  question. 


XL— RADIAL    PARALYSIS    IN    THE    HORSE. 

To-day  I  intend  to  speak  of  the  cases  of  radial  paralysis  we  have 
treated  during  the  course  of  the  present  session,  and  to  show  you  that 
this  paralysis  assumes  various  clinical  appearances  which  it  is  important 
you  should  recognise  if  you  wish  to  avoid  awkward  mistakes. 

Our  last  patient  affected  with  radial  paral3'sis  is  still  in  the 
clinique.  It  is  a  nine-year-old  Percheron  horse,  with  only  one  blemish, 
viz.  a  moderate-sized  bog-spavin.  You  have,  I  am  sure,  watched  it 
attentively,  for  its  history  is  extremely  interesting.  When  sent  to  us 
one  e\'ening  last  week  it  was  on  the  road  to  the  slaughterhouse.  An 
empiric,  practising  in  the  department  of  the  Seine  and  Oise,  had  the 
day  before  fired  it  in  lines  on  the  hock.  The  horse  had  thrown  itself 
down  violently,  and  on  rising  was  no  longer  able  to  place  weight  on 
the  off  fore-limb.  The  quack  declared  the  animal  had  fractured  a 
phalanx,  and  was  incurable.  The  owner  thereupon  sold  it  to  a  butcher 
in  Paris  for  the  sum  of  loo  francs,  reserving  to  himself,  however,  the 
right  to  send  it  here  for  examination,  so  that  the  question  as  to  its 
incurability  might  be  finally  decided. 

The  animal  walked  out  of  the  ambulance  without  much  difficulty. 
The  foot  of  the  so-called  fractured  limb  w^as  brought  to  the  ground 
resting  on  the  toe,  and  the  flexion  of  the  knee,  fetlock,  and  elbow  when 
at  rest,  as  well  as  the  excessive  flexion  of  the  last  joint  when  walking, 
immediately  suggested  to  me  that  the  animal  was  suff'ering  from  radial 
paralysis.  The  phalangeal  region,  like  all  the  other  parts  of  the  limb, 
showed  no  sign  whatever  of  fracture.  I  was  therefore  able  to  reassure 
the  owner,  and  the  sale  was  broken  off.  We  placed  the  animal  in 
slings.  Treatment  consisted  in  simple  massage  of  the  shoulder,  arm, 
and  forearm,  especially  of  the  extensors  of  the  forearm  and  metacarpus. 
At  the  end  of  forty-eight  hours  improvement  was  very  manifest.  At 
the  present  time — scarcely  a  week  after  the  accident — cure  is  complete, 
so  complete  that  there  is  not  the  slightest  irregularity  in  movement, 
and  it  would  be  impossible  for  a  stranger  to  say  that  the  animal  had 
suffered  from  parahsis. 


RADIAL    PARALYSIS    IN    THE    HORSE.  65 

In  my  portion  of  the  hospital  you  have  seen  three  other  horses 
affected  with  this  condition. 

At  the  commencement  of  last  March,  a  seven-year-old  mare  with 
paralysis  of  the  left  radial  nerve,  of  unknown  origin,  was  left  for  treat- 
ment. Having  suffered,  two  months  before,  from  pneumonia,  this 
mare  had  returned  to  work  without  showing  any  after  effects.  One 
morning  she  was  found  standing  on  three  legs,  quite  unable  to  place 
weight  on  the  near  fore-leg.  The  coachman,  who  had  driven  her  the 
day  before,  declared  that  she  had  neither  slipped  nor  fallen. 

When  at  rest  the  peculiar  position  of  the  near  fore-limb  was  strik- 
ing. The  joints  were  flexed,  the  extensor  muscles  of  the  forearm  sunk 
in,  the  elbow  dropped,  and  the  angle  of  the  shoulder-joint  straightened. 
In  consequence  of  the  fetlock  being  flexed,  only  the  toe  of  the  foot 
rested  on  the  ground.  During  movement  these  symptoms  became 
more  marked  ;  when  attempts  were  made  to  place  weight  on  the  limb 
the  leg  collapsed,  the  point  of  the  elbow  descended  to  an  excessive 
degree.  The  fetlock  was  markedly  flexed,  and  almost  touched  the 
ground.  Sensation  was  preserved  in  all  parts.  The  paralysis  espe- 
cially affected  the  extensors  of  the  forearm,  canon -bone,  and  phalanges. 
The  case  was  one  of  radial  paralysis,  caused,  without  doubt,  by  a  slip  in 
the  stable. 

The  muscles  supplied  by  the  radial  were  blistered,  and  two  drachms 
of  iodide  of  potash  given  daily  in  the  food.  During  the  first  week  there 
was  not  the  least  improvement.  At  the  commencement  of  the  third 
week  a  further  blister  was  applied.  Although  walking  was  still  very 
painful,  the  patient  was  exercised  night  and  morning.  On  the  first 
occasion  it  had  great  difficulty  in  advancing,  but  each  day  the  distance 
was  increased,  and  distinct  improvement  soon  occurred.  In  a  week 
remarkable  progress  had  been  made.  The  animal  still  went  lame,  but 
the  limb  was  hardly  flexed  at  the  moment  when  weight  was  placed  on 
it.     Cure  was  complete  in  a  month. 

In  November,  1897,  we  treated  a  fifteen-year-old  mare  affected  with 
radial  paralysis,  which  had  appeared  immediately  after  a  fall.  While 
drawing  a  cart  loaded  with  a  cow  the  mare  stumbled  and  fell  forwards. 
On  being  unharnessed  and  lifted  she  had  great  dii^culty  in  placing  any 
weight  on  the  off  fore-limb.  As  the  accident  happened  close  to  the 
School,  the  injured  animal  was  brought  in. 

The  off  fore-limb  was  rested  on  the  toe,  the  fetlock  and  knee  were 
flexed,  the  scapulo-humeral  angle  was  excessively  open,  and  the  elbow 
dropped.  Inside  the  upper  part  of  the  forearm  was  a  slightly  painful 
swelling,  the  size  of  a  man's  fist,  which  showed  no  fluctuation  or 
crepitation  such  as  is  usual  when  blood  is  extravasated.     The  muscles 

E 


66  CLINICAL    VKTERINARV    MEDICINK    AND    SURGERY. 

attached  to  the  olecranon  showed  occasional  slight  trembling  move- 
ments. Sensation  was  nowhere  diminished.  The  temperature  and 
chief  functions  were  normal. 

The  mare  was  placed  in  slings.  Several  times  per  day  the  extensor 
muscles  of  the  paralysed  limb  were  massaged;  2^  drachms  of 
iodide  of  potash  and  4^  ounces  of  sulphate  of  soda  were  given  daily. 
On  the  first  three  days  the  swelling  of  the  forearm  remained 
stationary.  Next  day  the  animal  was  depressed,  hung  back  from  the 
manger,  and  threw  its  whole  weight  on  the  slings.  The  elbow  region 
was  greatly  swollen,  hard,  and  onl}-  slightl}-  sensitive  to  pressure  ;  the 
swelling  extended  over  the  muscles  of  the  forearm.  The  appetite  was 
good,  and'temperature  normal. 

On  the  fifth  and  sixth  days  the  swelling  of  the  upper  part  of  the 
forearm  increased  in  prominence  and  extent.  On  palpation  it  seemed 
as  though  caused  by  liquid  extra vasated  between  the  muscular  layers. 
At  the  end  of  forty-eight  hours  it  began  to  diminish,  but  functional 
disturbance  remained  almost  as  marked  as  on  the  first  day.  During 
the  second  week  the  general  condition  gradually  impro\-ed.  A  daily 
dose  of  2  ounces  of  bicarbonate  of  soda  was  added  to  the  draught 
previously  given.  On  the  fifteenth  da}-  the  animal  was  taken  out  of 
slings  and  left  loose  in  its  box  ;  it  then  began  to  place  weight  on  the 
affected  limb.  From  this  time  onwards  improvement  was  rapid,  the 
limb  soon  being  extended  with  more  certaint}-  and  freedom.  At  the 
commencement  of  the  fourth  week  the  last  sj-mptoms  had  disappeared, 
and  the  animal  was  returned  home.  At  the  same  time  as  the  preceding 
patient  there  was  in  hospital  a  horse,  in  which  paralysis  of  the  right 
radial  nerve  had  occurred  during  operation  on  the  foot.  The  animal 
had  been  cast  on  the  right  side,  and  the  off  fore-leg  drawn  backwards 
and  fastened  to  the  corresponding  hock.  Being  very  strong  the  animal 
had  struggled  violently.  On  rising,  it  was  unable  to  bear  weight  on 
the  off  fore-leg.  The  upper  parts  of  the  limb  were  blistered.  As  at  • 
the  end  of  a  few  days  no  improvement  had  occurred,  the  horse  was 
sent  to  the  School. 

At  rest  the  injured  limb  \\as  half  fiexed,  the  toe  of  the  foot  alone 
touching  the  ground.  The  scapulo-humeral  angle  was  very  open,  the 
shoulder  dropped,  and  the  point  of  the  elbow  depressed.  The  skin 
covering  the  shoulder,  arm,  and  forearm  was  denuded  of  hair,  swollen, 
discharging  and  inflamed,  in  consequence  of  the  blisters  which  had 
been  applied.  Sensation  was  preserved  throughout  the  limb.  When 
walking,  the  leg  was  moved  forward  with  difficult}',  and  collapsed  when 
the  animal  tried  to  place  weight  on  it. 

The  horse  was   placed  in  sHngs,  and,  to  hasten  healing  of  the  skin 


RADIAL    PARALYSIS    IN    THE    HORSE.  67 

wound  due  to  the  blister,  carbolic  lotion  was  applied  to  the  scapulo- 
humeral and  antibrachial  regions.  Four  drachms  of  iodide  of  potas- 
sium were  given  daily.  The  wound  on  the  foot  was  covered  with  a 
surgical  wool  dressing  ;  it  healed  rapidly. 

For  a  week  the  paralysis  did  not  diminish  in  the  smallest  degree. 
The  horse  was  exercised  for  a  short  time  every  day,  and  the  parts 
massaged.     During  the  second  week  no  improvement  was  recorded. 

The  slings  were  then  removed,  the  iodide  of  potassium  was  discon- 
tinued, and  the  animal  was  exercised  for  twenty  minutes  night  and 
morning.  Movement  was  particularly  painful  at  first,  and  the  limb 
could  hardly  be  extended.  Improvement  did  not  commence  until  after 
a  month.  The  patient  then  began  to  walk  more  willingly  than  before, 
the  paralysed  limb  at  times  being  distinctly  extended.  The  muscles 
having  commenced  to  waste  to  a  marked  degree,  lo  c.c.  of  a  one  per 
cent,  solution  of  sulphate  of  veratrin  were  injected  under  the  skin,  and 
the  application  repeated  a  week  later.  For  a  fortnight  more  there  was 
little  improvement ;  afterwards  the  animal  recovered  with  fair  rapidit}-. 
As  time  passed,  more  and  more  weight  was  placed  on  the  limb,  and 
during  movement  the  parts  were  freely  extended.  The  last  symptoms 
did  not  disappear  until  the  commencement  of  the  third  month. 

Being  almost  entirel\-  confined  to  the  horse,  and  rare  in  other  animals, 
radial  paralysis  was  long  mistaken  for  articular,  bon}-,  or  muscular 
disease  of  the  shoulder  and  arm.  Continental  authorities  have  erro- 
neously attributed  to  Giinther  the  merit  of  having  in  1866  first  exactly 
described  it  in  his  '  Myologie.'  Goubaux,  in  his  "  Memoires  sur  les 
Paralysies  locales,"  which  appeared  in  the  Rccticil  de  Mcdccine  Vctc- 
rinaire,  just  half  a  centur}-  ago  set  forth  the  character  of  complete  and 
of  incomplete  paralysis  of  the  posterior  humeral  nerve.  Since  that  time 
a  large  number  of  cases  have  been  recorded. 

In  the  fore-limb,  movements  of  extension  are  specially  under  the 
control  of  the  radial.  It  supplies  the  muscles  attached  to  the  olecranon 
and  the  anterior  antibrachial  muscles,  the  five  extensor  muscles  of  the 
forearm,  the  anterior  extensor  of  the  metacarpus,  both  extensors  of  the 
phalanges,  and  by  a  branch  which  passes  in  a  backward  direction  the 
external  flexor  muscle  of  the  metacarpus.  On  account  of  its  position, 
course,  and  relations,  the  radial  is  exposed  to  compression  and  to 
mechanical  violence  :  it  is  therefore  much  more  frequently  the  seat 
of  injury  than  the  other  nerves  of  the  fore-limb.  Double  radial 
parah'sis  of  central  origin  is  said  to  have  occurred,  but  almost  all  the 
practitioner  is  called  on  to  treat  are  peripheral  unilateral  paralyses. 

The  ?etiolog}'  is  complex,  but  mechanical  injur}-  is  by  far  the  com- 


68  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

monest  cause  of  this  paralysis.  Bruises  about  the  shoulder  or  arm, 
kicks,  blows  from  the  carriage  pole,  collisions  against  the  jambs  of 
doors,  slips,  and  falls  may  all  produce  it.  Prolonged  compression 
resulting  from  the  animal  lying  in  an  awkward  or  enforced  position  is, 
however,  much  the  most  frequent  cause.  Radial  paralysis  is  often  a 
sequence  of  casting,  when  the  horse  has  been  kept  down  for  a  long 
time  with  its  legs  crossed,  or  in  the  ordinary  position,  and  especially 
when,  under  such  circumstances,  it  has  struggled  violently.  As  a  rule, 
though  not  always,  the  lower  limb  is  that  affected.  Notwithstanding 
the  assertion  of  Goubaux,  and  several  other  authors,  the  upper  limb 
may  be  the  seat  of  injury.  I  myself  have  seen  one  case.  In  operating 
on  a  fore-limb,  either  the  diseased  limb  itself  or  that  of  the  opposite 
side,  which  before  casting  was  perfectly  normal,  may  become  affected. 

Several  cases  of  radial  paralysis  occurring  during  work,  or  in  the 
stable,  and  quite  apart  from  mechanical  injury,  have  been  recorded. 
The  radial  may  certainly  become  paralysed  in  consequence  of  excessive 
contraction  of  the  muscles  which  it  supplies,  but  in  cases  of  this  kind 
either  the  nerve  itself  is  injured,  the  paralysis  is  due  to  inflammation  of 
muscle,  or  to  polymyositis  (inflammation  of  several  muscles)  conse- 
quent on  excessive  work. 

Paralysis  may  occur  in  the  stable  either  in  consequence  of  slipping, 
of  a  struggle  when  rising,  or  of  some  peculiar  position  in  which  the 
animal  is  accustomed  to  lie.  Rheumatic  paralysis,  or  paral3'sis  a 
frigore,  and  that  of  infectious  or  toxic  origin,  are  rare. 

The  co-existence  of  radial  paralysis  and  fracture  of  the  first  rib — a 
fracture  which  may  result  from  falls  or  slips — has  been  demonstrated  in 
many  post-mortems.  Hunting,  relying  on  several  cases  in  which 
fracture  of  the  first  rib  had  been  detected,  expressed  the  opinion  that 
radial  paralysis  was  probably  always  a  consequence  of  such  injury. 
This  conjecture,  however,  is  disproved  by  a  study  of  the  pathological 
anatomy  of  the  condition.  In  most  cases  post-mortem  examination  of 
animals  suffering  from  the  disease  fails  to  demonstrate  the  existence  of 
fracture  of  the  rib.  The  converse,  however,  is  true,  viz.  that  fracture 
of  the  upper  part  of  the  first  rib  is  usually  accompanied  by  radial 
paralysis — a  result  due  to  the  proximity  of  the  radial  nerve  to  the  point 
of  fracture. 

Radial  Paralysis  generally  produces  sufficient  functional  disturbance 
to  permit  of  diagnosis,  but  the  clinical  picture  is  far  from  clearly  defined. 
Sometimes  the  symptoms  are  very  acute  and  alarming,  leading  both 
skilled  and  unskilled  persons  to  suspect  some  extremely  grave  condition 
like  fracture,  as  in  the  case  we  have  just  seen  ;  sometimes  they  are 
obscure,  their  significance  only  becoming  clear  on  careful  examination. 


RADIAL    PARALYSIS    IN    THE    HORSE.  69 

These  cases  may  be  divided  into  three  groups,  viz.  Complete,  Incom- 
plete, and  Partial  Paralysis. 

In  Complete  Paralysis  the  joints  of  the  affected  limb,  with  the 
exception  of  the  shoulder,  are  usually  flexed  when  the  horse  is  resting. 
In  consequence  of  loss  of  power  in  the  triceps  and  anterior  brachial 
muscles,  the  arm  is  extended  and  straightened  on  the  shoulder,  the 
scapulo-humeral  angle  is  open,  and  the  elbow  depressed.  The  forearm 
is  flexed  on  the  arm  by  the  contraction  of  the  coraco-radialis,  while 
the  metacarpus  and  plalanges  are  bent  by  the  action  of  the  posterior 
antibrachial  muscles.  The  knee  is  carried  in  advance,  level  with,  or  in 
front  of,  a  vertical  line  dropped  from  the  point  of  the  shoulder.  The 
hoof  is  usually  rested  on  the  toe,  but  when  advanced  beyond  the  above- 
mentioned  vertical  line  it  may  be  placed  flat  on  the  ground,  the  joints 
then  being  less  markedly  bent.  When  the  limb  as  a  whole  is  flexed, 
it  may  be  brought  into  normal  position  by  thrusting  back  the  knee  with 
sufficient  force  to  counteract  the  action  of  the  flexor  muscles. 

In  walking,  the  shoulder  and  arm  are  more  or  less  "carried,"  the 
lame  limb  being  moved  as  a  whole  ;  but  as  the  lower  portions  of  the 
limb  are  insufficiently  extended,  the  stride  is  much  shortened.  The 
least  attempt  at  placing  weight  on  the  leg  causes  all  the  joints  to 
become  flexed,  and  the  shoulder  and  arm  to  suddenly  drop ;  the  animal, 
feeling  itself  falling,  instantly  transfers  weight  to  the  other  limb.  At  a 
more  rapid  pace  the  animal  goes  on  three  legs,  as  though  suffering  from 
some  exceedingly  painful  condition. 

Incomplete  Parahsis  may  either  constitute  a  stage  in  recovery  from 
complete  paralysis,  or  an  independent  condition.  At  rest  the  limb  is 
held  as  in  the  preceding  form,  but  the  entire  plantar  surface  of  the  hoof 
more  frequently  comes  in  contact  with  the  ground.  In  moving,  lame- 
ness is  less  marked,  and  instead  of  occurring  at  every  step  may  only 
appear  at  intervals,  varying  in  length  with  the  degree  of  paralysis, 
rapidity  of  movement,  and  smooth  or  rough  character  of  the  ground.. 
The  limb  is  slowly  advanced,  the  stride  shortened,  and  the  hoof  carried 
or  dragged  along  the  ground.  The  animal  stumbles  over  the  smallest 
obstacle,  the  limb  immediately  becoming  flexed. 

In  Partial  Paralysis  most  of  the  muscles  supplied  by  the  radial 
retain  their  function,  and  disturbance  is  much  less  marked.  As  a 
rule,  the  position  of  the  limb  at  rest  is  normal.  During  movement  it 
is  freely  extended,  the  stride  is  of  ordinar}-  length,  and  the  joints  do  not 
collapse  when  weight  is  placed  on  the  limb.  Slight  lameness  is  visible 
at  a  trot,  the  shoulder  and  arm  being  more  or  less  markedl}-  carried 
forward,  without,  howe\'er,  rolling  outwards,  as  in  paral}-sis  of  the  supra- 
scapular nerve. 


yo  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

Even  in  cases  of  complete  paralysis,  cutaneous  sensibility  is  usually 
normal,  or  only  slightly  diminished,  a  fact  attributed  to  the  less  sus- 
ceptibility to  injury  of  the  sensory  as  compared  with  the  motor  fibres. 
This  is  probably  an  error,  however,  the  persistence  of  sensation  being 
due  to  collateral  innervation,  any  deficiency  being  supplied  by  neigh- 
bouring nerves.  Sometimes  sensibility  to  pain  is  markedly  diminished, 
and  cases  are  not  infrequently  seen  in  which  the  anterior  and  external 
surfaces  of  the  forearm  are  anaesthetic.  Like  loss  of  sensation,  vaso- 
motor disturbance  is  rare,  though  abundant  perspiration,  corresponding 
in  area  to  that  of  the  paralysed  muscles,  has  been  described.  I  have  never 
seen  coldness  of  the  skin.  Localised  swelling  is  almost  alwa5's  due  to 
violence,  followed  by  haemorrhage  and  sanguineous  infiltration  of  the 
subcutaneous  and  muscular  tissues ;  though  it  may  also  follow  muscular 
rupture,  haemoglobinuria,  or  local  strain. 

The  condition  recognised  as  "radial  paralysis"  is  not  invariably  of 
nervous  origin  ;  sometimes  it  follows  muscular  injuries.  At  the  post- 
mortem of  certain  horses  which  had  been  over-driven,  and  showed 
symptoms  of  complete  radial  paralysis,  Frohner  found  the  radial  nerve 
intact,  whilst  the  muscles  it  supplies  were  swollen,  infiltrated,  and  yel- 
lowish ;  their  fibres  had  lost  the  normal  striation,  and  had  undergone 
granular  degeneration.  In  this  form  the  paralj^tic  symptoms  are 
accompanied  by  those  of  acute  inflammation  of  muscle. 

The  course  taken  by  radial  paralysis  depends  on  its  cause,  as  well 
as  on  the  gravity  of  injury  to  the  nerve  and  neighbouring  tissues  ;  but 
as  it  is  impossible  to  detect  the  actual  lesions,  nothing  precise  can  be 
said  on  this  head.  Sometimes  the  symptoms  diminish  within  a  few 
days,  and  the  animal  rapidly  recovers  ;  more  frequently  they  persist 
unchanged  for  several  weeks  :  improvement  then  occurs,  and  usually 
makes  good  progress.  The  paralysis  generally  persists  for  a  month  to 
six  weeks.  An  important  point  to  remember  is  that  recovery  is  the 
common  termination  of  simple  unilateral  radial  paralysis.  Of  sixty-eight 
recorded  cases,  only  two  proved  incurable,  i.  e.  a  proportion  of  about 
three  per  cent.  In  obstinate  cases  the  atrophy  of  muscle  which  occurs 
at  a  certain  stage  renders  prognosis  somewhat  graver.  Exercise  favours 
recovery,  but  it  is  important  not  to  return  animals  to  heavy  work  too 
■soon.  Relapses  have  often  been  seen,  and  are  almost  always  very 
troublesome.  I  should  add  that  this  paralysis  is  very  grave  under  two 
conditions  :  (i)  when  it  is  double-sided,  because  then  the  horse  is 
obliged  to  remain  lying  for  a  long  time  ;  and  (2)  when  an  animal,  in 
consequence  of  some  severe  operation  on,  say,  the  right  fore-foot,  has 
been  forced  to  remain  lying  for  a  long  time  on  the  left  side   (or  vice 


RADIAL    PARALYSIS    IN    THE    HORSE.  7 1 

versa),  and  paralysis  occurs  from  continued  pressure.  If,  under  such 
circumstances,  the  horse  cannot  stand  on  the  diseased  foot,  it  is 
evidently  in  great  danger. 

Diagnosis  presents  no  difficulty  except  in  partial  paralysis.  It 
should  be  remembered  that  in  most  attacks  of  this  kind,  when  the  horse 
is  trotted,  the  point  of  the  shoulder  is  jerked  forward  each  time  the  limb 
comes  to  the  ground,  while  lameness  is  marked.  You  will  therefore  not 
confuse  this  peculiar  jerking  movement  of  the  point  of  the  shoulder 
with  deviation  outwards — a  symptom  peculiar  to  paralysis  of  the  supra- 
scapular nerve  before  the  postea-spinatus  muscle  becomes  atrophied. 
The  symptoms  of  complete  radial  paralysis  are  at  first  sight  somewhat 
alarming,  and  explain  the  view  so  often  taken  by  owners,  dealers,  and 
quacks,  that  the  arm  or  one  of  the  phalanges  is  fractured.  Differential 
diagnosis  is  too  simple  to  require  my  speaking  on  it  at  length.  Fracture 
of  the  elbow  and  inflammation  of  muscle,  due  to  haemoglobinuria  or  to 
over-exertion,  are  both  clearly  indicated  by  their  respective  symptoms. 

As  radial  paralysis  often  follows  casting,  precautions  should  be 
taken  against  it,  the  animal  being  kept  down  as  short  a  time  as 
possible,  awkward  positions  being  avoided,  and  if  necessary  the  twitch 
being  applied  to  diminish  struggling. 

Curative  treatment  is  similar  to  that  of  other  paral3-ses  of  peripheral 
origin.  It  consists  in  massage  of  the  affected  parts,  cold  douches, 
local  hypodermic  injections  of  \eratrine  or  salt  solution,  the  induced 
electric  current,  and  the  administration  of  potassium  iodide  or  sodium 
salicylate. 

In  complete  paralysis  it  is  often  advantageous  to  sling  the  animal 
for  a  week  or  two.  Massage  and  cold  douches,  or  light  blisters  and 
exercise,  are  usually  sufficient.  As  soon  as  the  affected  muscles  begin 
to  recover  their  contractility,  improvement  rapidly  follows  on  exercitiC. 
The  animal  only  requires  to  be  moved  for  fifteen  or  twenty  minutes 
night  and  morning,  and  left  at  liberty  in  a  box.  Electricity — and 
particularly  the  faradic  current — is  at  present  rarely  employed.  I  have 
not  used  it  in  any  of  my  cases.  Salicylate  of  soda  is  only  indicated 
when  the  existence  of  rheumatism  is  feared.  I  prescribe  potassium 
iodide  with  the  object  of  assisting  reabsorption  of  exudate  in  the 
traumatic  area,  an  exudate  which  might  otherwise  become  organised, 
with  serious  consequences  to  the  affected  ner\e. 

More  complex  treatment  has  been  recommended,  but  the  above  is 
that  almost  always  followed. 

Radial  paralysis,  I  may  remark  in  conclusion,  tends  naturally 
towards  recovery. 


XIL— THE    TREATMENT    OF    SPAVIN. 

During  a  previous  lecture  I  stated  that  spavin,  like  most  other 
exostoses  of  mechanical  or  traumatic  origin,  produced  by  violent 
strains  during  movement  or  by  concussion,  gives  rise  to  lameness 
during  its  period  of  development.  This  is  usually  first  treated  by  rest, 
and  blisters  to  the  internal  surface  of  the  base  of  the  hock.  In  this 
way  some  cases  soon  become  sound,  but  in  the  majority  lameness 
either  continues  unchanged  or  returns  intermittently. 

Pathological  anatomy  affords  the  explanation  of  this  persistent 
lameness  by  demonstrating  the  existence  not  only  of  a  limited  osteo- 
periostitis of  the  superficial  layers  of  the  affected  bones,  but  of 
articular  lesions.  Veterinary  surgeons  have  long  been  agreed  on  this 
point.  The  question  at  present  in  dispute  is — Which  of  the  morbid 
changes  in  this  complex  process  occurs  first  ?  What  is  the  primary 
lesion  ?  Is  the  mischief  at  first  confined  to  the  points  of  insertion  of 
ligaments,  and  must  we  regard  the  changes  in  the  lower  joints  of  the 
hock  as  secondary ;  or,  does  spavin  originate  in  the  depths  of  the 
articulation,  and  is  the  bony  swelling  which  appears  after  a  certain 
time,  only  a  consequence  of  articular  inflammation  extending  to  the 
periosteum  ?  Or,  again,  does  inflammation  of  the  joint  occur  simulta- 
neously with  that  of  the  periosteum,  and  do  the  two  develop  together  ? 
Many  different  opinions  have  been  enunciated. 

Aronsohn  has  recently  carried  out  some  in\-estigations  tending  to 
confirm  those  of  Goubaux  and  Barrier,  and  favourable  to  the  doctrine 
that  spavin  starts  externally.  According  to  this  author,  the  disease 
commences  as  a  periostitis,  due  to  hyper-extension  of  the  internal 
tarsal  ligaments  and  tendon  of  the  flexor  metatarsi.  The  arthritis 
which  occurs  in  the  lower  tarsal  joints  is  regarded  as  always  secondary. 

Aronsohn's  memoir  appeared  in  1893.  He  states  that  Eberlein, 
Joly,  and  Barrier  have  all  carried  out  important  investigations  on  the 
pathology  of  spavin.     The  conclusions  are  as  follows  : 

According  to  Eberlein  the  first  lesion  of  spavin  consists  in  osteo- 


THE    TREATMENT    OF    SPAVIN.  73; 

porosis  and  rarefying  ostitis,  in  the  great  majority  of  cases  affecting  the 
cuneiform  bones  and  the  metatarsus.  This  rarefying  ostitis  is  soon 
succeeded  by  condensing  arthritis.  At  the  same  time  the  corre- 
sponding articular  cartilages  become  the  seat  of  chondritis,  with  pro- 
liferation of  cartilage  cells  and  degeneration  of  the  fundamental 
substance,  resulting  sooner  or  later  in  anchylosis  of  the  joints  in 
question.  Often,  though  not  invariably,  inflammation  extends  to  the 
joint,  or,  possibly,  directly  from  the  bone  to  the  periosteum  of  the 
small  tarsal  bones,  and  there  produces  an  ossifying  periostitis,  accom- 
panied by  exostoses  on  the  inner  surface  of  the  lower  line  of  bones  of 
the  hock.  The  lesions  seen  in  the  tissues  surrounding  the  joint  are 
secondary. 

M.  Joly  considers  that  what  is  called  spavin,  and  treated  under 
that  name,  is  a  complex  pathological  process,  the  stages  of  which  are 
as  follows  : — (i)  Dry  arthritis  of  the  lower  tarsal  joints  ;  this  is  spavin 
arthritis.     (2)  Anchylosis  of   the    inflamed  joints — spavin  anchylosis. 

(3)  Exostosis,  localised,  in  consequence  of  the  anatomical  formation  of 
the  hock,  at  the  infero-internal  surface  of  the  joint — spavin  exostosis. 

(4)  Extension  of  the  disease  to  the  lower  tarsal  joints,  and  invasion  of 
the  tarso-metatarsal  joints  and  superior  tarsal  joints — circular  spavin. 

The  author  states  that  these  four  phases  of  the  disease  do  not 
succeed  in  regular  order  throughout  the  entire  extent  of  the  hock.  On 
the  contrar}',  the\'  extend  by  zones,  gradually  invading  wider  areas, 
one  zone  having  terminated  its  second  or  third  cycle  when  the  next  is 
only  in  the  primary  stages. 

M.  Barrier  considers  that  spavin  consists  essentially  in  a  dry  chronic 
arthritis,  usually  leading  to  anchylosis  and  deformity.  It  starts  in  the 
joints  at  the  infero-internal  surface  of  the  hock,  and  tends  to  travel 
from  below  upwards,  and  from  within  outwards. 

The  evolution  of  the  morbid  process  which  ends  in  spavin  forma- 
tion may  be  summarised  as  follows  : — (i)  Strain  of  the  ligamentous 
structures,  either  at  the  surface  or  in  the  depths  of  the  small  tarsal 
joints.  (2)  Ostitis  and  osteo-periostitis,  at  first  of  a  rarefying,  then  of 
a  condensing  character,  of  the  osseous  structures  affected,  or  of  neigh- 
bouring parts,  under  the  influence  of  concussion.  (3)  Peripheral 
anchylosis,  sometimes  without  deformity,  but  usually  with  new  growths 
of  bone,  which  later  tend  to  envelop  the  joint.  (4)  Dry  arthritis,, 
ending  either  in  central,  very  firm  anchylosis,  or  in  progressive 
osteoporotic  deformation,  or  in  eburnation  of  the  diseased  articular 
surfaces. 


74  CLINICAL    VETERINARY    MEDICINE    AND    SURdERY. 

I  believe  that  on  this  question  of  the  pathology  of  spavin,  as,  for 
that  matter,  of  the  pathology  of  other  affections,  it  is  very  necessary 
to  avoid  dogmatism.  Because  it  is  proved  that  a  certain  cause  or 
process  occurs,  that  is  no  sufficient  reason  for  absolutely  neglecting 
those  whose  influence  is  more  difficult  to  demonstrate.  The  causes  of 
spavin  are  certainly  many.  Defective  conformation  of  the  hock,  injury 
suffered  during  movement,  and  strains  of  ligaments  probably  play 
important  parts ;  while  the  constitutional  condition  of  the  animals  and 
the  character  of  the  bony  tissue — consequently  hereditary  predisposition 
— must  not  be  lost  sight  of. 

We  cannot  explain  why  or  how  the  bones  which  form  the  lower 
portions  of  the  hock,  the  synovial  membranes  interposed  between 
them,  and  the  ligaments  which  unite  them,  should  be  exempt  from 
morbid  processes  which  attack  bones  and  serous  and  fibrous  mem- 
branes ;  why,  for  instance,  they  should  be  exempt  from  injury  by 
products  of  microbic  activity.  Whatever  its  cause,  however,  unless  the 
inflammation  in  the  periosteum,  in  the  bones,  or  in  the  affected  joints 
is  allayed,  lameness  results.  Another  cause  of  lameness  persisting  is 
the  mechanical  disturbance,  the  interference  with  the  action  of  the 
hock  caused  by  bony  growths — a  disturbance  which  is  possibly  of  less 
importance  than  is  usually  admitted,  and  which  is  certainly  not  con- 
stant. We  sometimes  see  large  spavins  which,  however,  do  not  render 
horses  lame.  Furthermore,  spavin  very  rarely  interferes  with  the  action 
of  the  tibio-astragalar  joint. 

The  essential  point  in  dealing  with  spavin  lameness  is  to  allay  the 
inflammation  developed  in,  or  propagated  to  the  lower  tarsal  joints, 
by  producing  anchylosis  of  these  joints.  Even  when  treatment  follows 
close  on  the  appearance  of  the  disease,  it  is  hopeless  to  attempt 
checking  the  inflammation  or  arresting  its  course.  Treatment  should 
aim  at  hastening  the  evolution  of  the  process  and  the  production  of 
anchylosis.  In  this  way  the  period  of  pain  may  be  shortened,  and 
without  doubt  the  extent  of  the  morbid  changes  diminished. 

In  old  spavins,  or  in  those  which,  though  relatively  recent,  are 
producing  lameness,  and  which  have  resisted  blisters  or  superficial 
firing,  what  is  the  best  treatment  ? 

Among  the  methods  suggested  three  stand  pre-eminent,  and  usually 
suffice  :  deep  penetrating  firing,  tenotomy  of  the  flexor  metatarsi 
tendon,  and  periosteotomy. 

Firing  in  fine  deep  points  is  nowadays  the  treatment  most  commonly 
emploj-ed,  and  when  used  boldly,  so  that  the  red-hot  needle  penetrates 
the  exostosis,  often  gives  good  results.     vSection  of  the  inner  terminal 


THE    TREATMENT    OF    SPAVIN.  75 

tendon  of  the  flexor  metatarsi  by  the  old  open  method  has  been  so 
successful  that  certain  operators  declare  it  superior  to  firing.  I  usually 
combine  these  two  methods,  first  piercing  the  exostosis  with  a  finely 
pointed  Paquelin  cautery,  or  with  the  end  of  a  medium-sized  knitting- 
needle  brought  to  a  bright  red,  and  afterwards  making  twenty,  thirty, 
or  forty  similar  points,  extending  a  little  beyond  the  area  of  the  swell- 
ing. In  large  or  old-standing  spavins  I  apply  the  cautery  twice,  or 
sometimes  three  times,  in  each  puncture.  Following  this  I  simply 
divide  the  tendon  of  the  flexor  metatarsi,  or  I  excise  a  short  portion. 

The  numerous  instances  I  have  recorded  during  the  last  few  years 
show  that  this  treatment  removes  spavin  lameness  in  about  30  per 
cent,  of  cases.  I  do  not  believe  that  any  other  direct  treatment  is  so 
efficient  against  osteo-arthritis  of  the  hock.  The  only  objection  I  can 
make  to  it  is  that  it  leaves  a  more  or  less  apparent  mark. 

Penetrating  firing,  nowadays  used  by  a  large  number  of  practitioners, 
produces  much  more  intense  immediate  effects  and  much  better  results 
than  the  old  superficial  firing,  and  does  not  necessitate  nearly  so  long 
rest.  The  time  for  operation  can  be  shortened.  Instead  of  covering 
the  entire  surface  with  closely  placed  points,  three  to  six  may  be  used, 
according  to  the  size  of  the  bony  tumour  ;  and  these  can  be  applied 
after  placing  a  twitch  on  the  upper  lip,  and  lifting  one  of  the  fore-feet, 
i.  c.  without  casting  the  animal.  Frohner,  who  has  treated  fifty-nine 
spavins  in  this  way,  states  he  had  very  good  results  last  year.  You  see 
the  advantages  of  this  method :  it  avoids  the  necessity  for  casting  the 
animal  and  saves  a  great  deal  of  time,  for  the  operation  only  lasts  a 
few  minutes.  It  is  true  that  penetrating  firing  of  the  hock  is  some- 
times followed  by  arthritis,  but  this  complication  has  become  excep- 
tionally rare  since  the  introduction  of  very  finely  pointed  cauteries.  It 
can  more  certainly  be  avoided  by  operating  with  antiseptic  precautions. 
The  hair  is  cut,  and  the  skin  shaven  over  the  entire  surface  of  the  bony 
swelling.  The  field  of  operation  is  disinfected,  firing  performed,  and 
the  cauterised  surface  covered  with  iodoform  collodion. 

Periosteotomy,  when  practised  aseptically,  according  to  Peters' 
direction,  has  the  advantage  over  the  preceding  of  leaving  no  mark. 
A  narrow  transverse  incision  is  made  at  the  base  of  the  swelling, 
opposite  its  vertical  axis,  and  the  exostosis  cut  into  at  several  points, 
using  a  button-pointed  bistoury  with  a  convex  cutting  edge.  But  at 
present  I  have  not  sufficient  personal  experience  of  this  operation  to 
deliver  an  opinion  concerning  it.  Those  authors  who  have  written  on 
the  subject  vary  greatly  in  opinion  regarding  it  ;  but  it  has  given 
successes  and  might  prove  useful,  especially  in  valuable  horses. 


76 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


In  a  number  of  cases  where  the  swelhng  is  old,  large,  diffuse,  and 
especially  when  it  extends  far  forwards  towards  the  bend  of  the  hock, 
firing,  even  if  repeated,  and  section  of  the  terminal  branch  of  the  flexor 
metatarsi  tendon  fail,  or  only  yield  a  very  modified  success  ;  lame- 
ness persists  or  is  remittent,  being  less  marked  after  a  certain  amount 
of  exercise  than  on  leaving  the  stable,  though  sometimes  it  is  equally 
pronounced  before  and  after  exercise  :  in  these  rebellious  cases  double 
neurotomy  of  the  sciatic  and  anterior  tibial  nerve,  a  deep  branch  of  the 
external  popliteal  sciatic,  has  been  recommended.  This  treatment  of 
obstinate  spavin  by  neurectomy  is  based  on  the  following  anatomical 


Fig.  8. 


P"lG,  9. 


Figs.  8  and  9. — Neurotomy  of  the  anterior  tibial  nerve.  E  A,  anterior  extensor  of  the 
phalanges.  E  L,  lateral  extensor.  F  M,  muscular  portion  of  the  flexor  metatarsi. 
N,  tibial  nerve.  V,  tibial  vein.  A,  tibial  artery.  (The  operation  should  be  performed 
a  little  nearer  the  hock  than  indicated  on  Fig.  8.) 

facts  : — Opposite  the  point  of  the  calcis  the  great  sciatic  nerve  divides 
into  two  parts,  the  internal  and  external  plantar  nerves.  Behind  the 
hock-joint  the  external  plantar  nerve  gives  off  a  fairly  large  branch, 
which  passes  under  the  tendon  of  the  deep  flexor  of  the  phalanges,  and 
detaches  several  twigs,  of  which  some  ramify  over  the  surface  of  the 
joint,  whilst  others  penetrate  into  it.  In  front  of  the  lower  extremity 
of  the  tibia  the  tibial  nerve  gives  off  several  branches,  which  enter  the 
joint. 

Neurectomy  of  the  great  sciatic  is  made  a  hand's  breadth  above  the 
point  of  the  hock.     Ycm  know  the  technique. 


THE    TREATiMENT    OF    SPAVIN.  77 

In  neurectomy  of  the  tibial,  the  point  selected  is  at  the  external 
surface  of  the  lower  part  of  the  thigh,  approximately  at  the  same 
height  as  the  former.  The  anterior  tibial  nerve  is  situated  on  the  deep 
surface  of  the  anterior  extensor  of  the  phalanges,  between  this  muscle 
and  the  thin  muscular  portion  of  the  flexor  metatarsi  which  separates 
it  from  the  tibial  artery,  and  from  its  large  satellite  vein — vessels 
which  lie  directly  on  the  anterior  surface  of  the  tibia,  where  they 
are  surrounded  by  a  thick  layer  of  connective  tissue. 

The  method  is  as  follows  : — The  point  of  operation  being  prepared, 
the  skin  and  subjacent  aponeurosis  are  incised  for  a  distance  of  two 
and  a  half  to  three  inches,  opposite  the  external  margin  of  the  anterior 
extensor  of  the  phalanges.  This  muscle  is  separated  from  the  lateral 
extensor,  then  from  the  muscular  portion  of  the  flexor  metatarsi,  on  the 
anterior  surface  of  which  the  tibial  nerve  is  readily  discovered.  A 
fragment  of  this,  three  quarters  of  an  inch  to  one  and  a  quarter  inches 
in  length,  is  excised.  The  wound  is  closed  by  a  few  cutaneous  sutures, 
with  or  without  providing  for  drainage.  The  operation  is  eas}-.  It  is, 
however,  always  necessary  to  proceed  methodically,  and  to  take  care 
not  to  injure  the  tibial  vein,  which  thrusts  the  muscular  portion  of  the 
flexor  metatarsi  prominently  forwards  as  soon  as  the  anterior  extensor 
of  the  phalanges  is  reflected. 

This  double  neurectomy  has  proved  successful  when  all  other 
methods  had  failed.  Bosi  reported  six  favourable  cases,  and  more 
recently  Frohner  has  described  others.  Nevertheless  it  is  not  without 
danger,  trophic  changes  in  the  extremities,  local  sloughing,  and  loss  of 
the  hoof  sometimes  occurring. 

I  may  summarise  the  treatment  of  spavin  as  follows  : — At  first,  when 
the  disease  is  still  latent,  prolonged  rest  and  blisters ;  later,  when 
spavin  is  apparent,  firing  in  deep  penetrating  points,  and  when  the 
exostosis  is  large,  section  of  the  internal  terminal  tendon  of  the  flexor 
metatarsi.  Should  improvement  only  be  partial,  repeat  the  firing ; 
finally,  if  repeated  firing  fails,  you  may,  after  warning  the  owner  of 
possible  risk,  perform  neurectomy  of  the  sciatics. 

The  heredity  of  certain  organic  conditions  which  favour  the  pro- 
duction of  spavin  suggests  the  only  prophylactic  measure  applicable  in 
our  practice,  viz.  to  avoid  breeding  from  animals  with  this  disease,  or 
from  those  with  specially  defective  hocks. 


XIII.— THE  TREATMENT  OF  PICKED-UP  NAIL. 

Since  the  commencement  of  the  year  I  have  several  times  lectured 
on  the  treatment  of  wounds  of  the  lower  surface  of  the  horse's  foot,  and 
have  described  to  you  the  methods  of  treating  recent  and  complicated 
wounds  in  each  of  the  parts  into  which  this  region  has  been  conven- 
tionally divided. 

To-day  I  return  to  the  treatment  of  grave  cases  of  picked-up  nail 
in  the  middle  zone,  in  order  to  study  in  some  detail  two  modifications 
which  can  be  made  in  the  technique  of  the  complete  operation,  and  to 
show  you  the  benefits  resulting  therefrom. 

I  wish  to  recall  to  your  memory  the  conditions  for  which  this  opera- 
tion is  performed,  viz.  penetrating  wounds,  complicated  with  exten- 
sive and  deep  necrosis  of  the  plantar  aponeurosis,  or  with  purulent 
synovitis  of  the  navicular  or  small  sesamoid  sheath. 

The  complete  operation  for  picked-up  nail,  as  given  by  Andre  and 
described  by  Bouley  and  Trasbot,  consists  of — (i)  a  large  incision 
through  the  plantar  cushion ;  (2)  transverse  section  of  the  plantar 
aponeurosis  opposite  the  posterior  margin  of  the  navicular  bone,  pro- 
longed on  each  side  as  far  as  the  retrorsal  processes ;  (3)  removal  of  the 
terminal  portion  of  this  aponeurosis ;  (4)  scraping  the  lower  surface  of 
the  navicular  bone  and  that  portion  of  the  pedal  bone  over  which  is 
inserted  the  above-mentioned  aponeurosis. 

In  1879  M.  Nocard  recommended  preserving  the  insertion  of  the  apo- 
neurosis into  the  pedal  bone  by  making,  opposite  the  posterior  margin 
of  the  navicular  bone  from  one  lateral  lacuna  to  the  other,  an  incision 
perpendicular  to  the  median  line  of  the  foot,  and  b}-  giving  to  the  two 
extremities  of  this  incision,  from  the  lacuna  to  the  semilunar  crest,  a 
curved  or  concave  form,  looking  forwards.  Retraction  of  the  stump  of 
the  tendon  is  thus  avoided.  As  the  tissue  composing  the  plantar  cushion 
granulates  more  rapidl}'  than  that  of  the  aponeurosis,  it  used  to  be  the 
custom  to  excise  this  part  very  freely,  dividing  it  far  back  at  the  boun- 
dary between  its  middle  and  posterior  thirds,  or  even  within  this,  the 
incision  taking  an  oblique  direction  from  behind  forwards. 

Ten  years  ago  I  showed  that  scraping  the  surface  of  insertion  of  the 


THE    TREATMENT    OF    PICKED-UP    NAII,.  79 

aponeurosis  is  superfluous,  and  that  under  an  antiseptic  dressing  the 
fibrous  tissue  left  covering  the  os  pedis,  far  from  undergoing  necrosis 
(as  had  been  suggested),  rapidly  becomes  vascular  and  covered  with 
granulations,  like  the  other  tissues  in  the  wound.  Even  where  necrosis 
has  affected  a  portion  of  the  end  of  the  aponeurosis,  you  have  always 
seen  that  I  limited  remo\al  of  the  fibrous  la3'er  and  scraping  of  the  bone 
to  that  particular  portion. 

By  thus  preserving  the  fibrous  covering  of  the  pedal  bone  o\-er  the 
entire  surface  of  insertion  of  the  perforans  tendon,  operation  is  simpli- 
fied— scraping  being  a  delicate  process,  which  endangers  the  interosseous 
ligament, — the  chance  of  arthritis  is  less,  and  the  anterior  portion  of  the 
wound  fills  up  more  rapidly  than  after  curetting  the  semilunar  crest. 

But  in  consequence  of  the  obliquity  with  which  the  plantar  cushion 
is  divided,  especially  when  the  necrotic  portion  of  the  aponeurosis 
extends  to  or  a  little  behind  the  posterior  margin  of  the  navicular  bone, 
the  operation  wound  is  very  large,  sometimes  almost  alarming  in  size ; 
and  healing,  even  when  uncomplicated,  occupies  a  long  time — some  six 
to  eight  weeks.  The  majority  of  patients  only  return  to  work  after 
extended  rest. 

Whatever  the  position  of  the  necrosis  or  of  the  penetrating  wound 
in  the  navicular  sheath,  the  period  of  healing  and  consequently  the 
required  rest  may  be  diminished  by  sparing,  as  far  as  possible,  the 
plantar  cushion,  and  reducing  to  a  minimum  the  loss  of  substance  b}- 
making  the  primary  incision  at  right  angles  to  the  surface  of  the  plantar 
region,  or  even  inclined  a  little  obliquel}-  from  in  front  backwards. 
Antiseptic  treatment  and  plugging  of  the  wound  with  gauze  prevents 
the  complications  which  caused  older  operators  to  excise  the  plantar 
cushion  so  freely.  You  will  at  once  see  the  advantages  of  this  method, — 
more  rapid  closure  of  the  operative  wound,  and  a  smaller  cicatrix,  the 
tenderness  of  which  is  sometimes  the  only  reason  for  lameness  persist- 
ing ;  in  a  word,  more  rapid  and  complete  reco\'ery. 

You  have  been  able  personally  to  estimate  these  advantages  in  a 
certain  number  of  our  cases.  I  may  repeat  to  you  the  histor}-  of  the 
most  recent. 

On  the  15th  March  last  a  heavy  seven-)-ear-old  cart  mare  entered 
hospital.  Three  weeks  before  she  had  picked  up  a  nail  about  the 
centre  of  the  left  hind  foot.  The  nail  had  penetrated  perpendicularly 
into  the  internal  lacuna,  not  far  from  the  limit  between  the  middle  and 
posterior  zones.  A  veterinary  surgeon  had  thinned  the  sole  around  the 
wound,  which  he  had  laid  open  and  disinfected,  and  had  afterwards 
covered  the  parts  with  an  iodoform  dressing.  Despite  this  treatment 
the  wound  became  complicated.      Towards  the  end  of  the  second  week 


So  CLINICAL    VETKRINARY    .MKDICINE    AND    SURGERY. 

lameness  was  extremely  marked,  and  five  or  six  days  later  the  patient 
was  sent  here.  When  seen  by  us  the  left  hind  foot  was  scarcely 
brought  in  contact  with  the  ground,  the  lower  part  of  the  limb  was 
greatly  swollen,  and  the  animal  continually  lifted  the  foot,  showing 
signs  of  darting  (lancinating)  pain.  Pus,  mixed  with  synovia,  escaped 
from  the  wound  on  the  under  surface  of  the  foot,  around  which,  for 
a  distance  of  an  inch,  the  exposed  sensitive  tissues  were  swollen 
and  exuberantly  granulating.  The  case  was  one  of  picked-up  nail, 
complicated  by  suppurative  inflammation  of  the  small  sesamoid  (navi- 
cular) sheath,  and  possibly  by  necrosis  of  the  plantar  aponeurosis.  We 
might  have  thinned  the  foot,  laid  open  the  sinus,  and  afterwards  used 
baths  and  antiseptic  dressings,  but  such  treatment  gave  little  hope  of 
success.  Operation  was  evidently  preferable,  and  was  arranged  for  the 
day  afterwards. 

The  usual  method  was  employed,  with  the  modification,  however, 
of  which  I  have  just  spoken.  After  stripping  the  sole  I  divided  the 
plantar  cushion  at  right  angles  to  its  surface,  so  as  to  preserve  the 
larger  part.  The  plantar  aponeurosis,  being  exposed,  was  divided 
transversely,  a  little  in  front  of  the  posterior  margin  of  the  navicular 
bone,  and  dissected  away,  the  sides,  however,  being  spared  as  much  as 
possible.  The  nail  had  touched  the  inner  facet  of  the  navicular,  where 
it  had  produced  a  small  wound  and  a  patch  of  ostitis.  I  curetted  the 
lower  surface  of  the  bone,  forming  a  slight  depression  at  the  injured 
point.  In  the  excised  portion  of  the  aponeurosis  was  a  necrotic  ring 
surrounding  the  sinus  ;  the  stump  showed  a  greyish  point,  where  the 
fibres  were  a  little  softened  and  possibly  necrotic,  but  the  terminal 
portion  of  the  aponeurosis  was  healthy  over  its  entire  area  of  insertion, 
and  was  therefore  not  touched.  I  did  not  interfere  with  the  pedal 
bone.  Having  freely  irrigated  the  wound  with  lukewarm  two  per  cent, 
carbolic  solution,  the  greyish  point  on  the  end  of  the  tendon  was  touched 
with  tincture  of  iodine,  which  was  also  applied  to  the  hollow  formed  in 
the  navicular  bone,  the  wound  was  powdered  with  iodoform,  and  after- 
wards plugged  with  gauze.  To  prevent  discharge  accumulating  in  the 
cul-de-sac  behind  the  tendon  sheath,  I  was  careful  to  lift  the  end  of  the 
aponeurosis  and  pass  the  gauze  under  it.  Finally  I  applied  the  surgical 
dressing  usually  employed  after  serious  operations  on  the  foot. 

On  rising  the  mare  placed  more  weight  on  the  diseased  limb,  and 
appeared  in  less  pain  than  before  operation.  That  evening  the  tempe- 
rature rose  to  39"3°  C.  (1027°  F.).  The  day  after  the  foot  was 
rested  on  the  toe,  and  the  animal  suffered  from  lancinating  pain  ;  but  it 
ate  most  of  its  food,  the  general  condition  was  satisfactory,  and  the 
fever  moderate.       During  the  first  week  the  condition  remained  prac- 


THE    TREATMENT    OF    PICKED-UP    NAIL.  61 

tically  stationary,  any  change,  however,  being  towards  improvement. 
The  temperature  never  rose  beyond  39"3^C.  (1027°  F.).  On  the  eighth 
day  more  weight  was  placed  on  the  foot,  and  the  lancinating  pain  had 
disappeared.  The  dressing  was  removed.  To  loosen  the  gauze  which 
adhered  to  the  deeper  parts,  the  foot  was  placed  in  warm  carbolic  solu- 
tion. There  was  only  a  little  reddish  discharge  ;  the  wound  appeared 
very  healthy  and  granulations  were  everywhere  springing  up,  except  on 
the  navicular  bone  and  in  the  stump  of  the  perforans  tendon,  where 
preparations  for  granulation  were  seen.  After  thorough  cleansing,  the 
parts  were  again  covered  with  a  cotton-wool  dressing. 

On  the  tenth  day  the  patient's  condition  was  excellent;  fever  had 
ceased,  and  weight  began  to  be  placed  on  the  affected  limb.  On  the  four- 
teenth day  the  dressing  was  renewed.  The  layer  of  gauze  was  moist ;  the 
wound,  which  contained  a  little  pus.  was  entirely  covered  with  granula- 
tions. A  thin  shoe  was  applied,  with  four  nails,  and  the  surgical 
dressing  fixed  in  position  with  splints. 

After  the  eighteenth  day  improvement  occurred  rapidly.  The  animal 
still  walked  lame,  but  placed  more  weight  on  the  leg.  Exercise  was 
commenced,  night  and  morning.  A  week  later  the  wound  was  about 
three  quarters  healed,  and  the  lameness  scarcely  noticeable  at  a  walk. 
Twenty-four  days  after  operation  the  mare  was  able  to  do  a  little  work. 
She  did  not  leave  hospital,  however,  for  another  week.  At  that  time 
lameness  was  scarcely  perceptible  when  walking. 

It  may  be  said  that,  of  course,  this  injury  was  in  a  hind  foot,  and 
that  injuries  to  fore-feet  are  graver,  and  treatment  would  be  more  pro- 
longed. But  two  months  after  this  case  I  operated  in  the  same  way 
on  another  horse,  which  had  picked  up  a  nail  in  the  off  fore-foot.  The 
case  was  also  complicated  with  necrosis  of  the  aponeurosis  and  with 
purulent  synovitis.  The  result  was  as  favourable  as  in  the  preceding 
instance,  and  the  period  of  treatment  not  much  longer.  The  horse,  in 
fact,  returned  to  work  in  five  weeks.  A  little  later  the  then  existing 
lameness  had  completely  disappeared. 

By  preserving  the  larger  portion  of  the  plantar  cushion  not  only  is  the 
period  of  healing  diminished,  but  the  volume  and  area  of  the  mass  of 
resulting  cicatricial  tissue  are  reduced.  This  cicatricial  tissue  often 
remains  excessively  sensitive,  keeping  up  lameness  even  where  there  is 
no  periostosis  or  marked  swelling  about  the  coronet.  The  more  you 
preserve  the  plantar  cushion,  the  smaller  will  be  the  cicatrix  and  the 
more  certain  and  complete  the  result  of  treatment. 

On  this  first  point,  I  may  remark,  it  is  not  always  necessary  to 
divide  the  plantar  cushion  perpendicularly  to  the  long  axis  of  the  foot, 
as  you  usually  do  in  the  animals  provided  for  exercises  in   practical 

F 


82  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

surgery.  To  avoid  excessive  cutting,  and  to  reduce  as  far  as  possible 
the  extent  of  the  wound,  one  may  depart  from  the  rule  ;  and  if  the  sinus 
is  in  one  of  the  lateral  lacunas,  far  enough  removed  from  the  point  of 
the  sensitive  frog,  if  necrosis  is  limited  to  one  half  of  the  aponeurosis, 
or  is  situated  near  one  of  its  margins,  you  may  make  the  transverse 
incision  through  the  aponeurosis  and  plantar  cushion  more  or  less 
oblique  to  the  long  axis  of  the  foot,  and  thus,  while  removing  the  whole 
of  the  necrotic  patch,  preserve  on  the  opposite  side  the  larger  propor- 
tion of  the  healthy  tissues. 

By  lifting  the  end  of  the  aponeurosis  with  the  flattened  end  of  a 
director  or  any  blunt  object,  it  becomes  easy  to  separate  the  cartilaginous 
material  surrounding  the  navicular  bone  with  a  button-pointed  knife, 
or  a  cautiously  handled  sharp-pointed  knife.  In  practice,  therefore,  it  is 
sometimes  advisable  to  depart  from  the  rules  of  the  classical  operation. 
Different  cases  require  different  treatment,  and  it  is  always  important  to 
preserve  tissue  as  far  as  possible. 

With  the  advent  of  antisepsis  the  surgery  of  the  foot  has  become 
more  conservative.  In  complicated  injuries  of  the  plantar  region,  in 
particular,  we  should  endeavour  to  reduce  the  operative  wound  to  the 
smallest  dimensions. 

Let  us  now  consider  the  treatment  of  necrosis  of  the  plantar 
aponeurosis,  occurring  close  to  the  synovial  cul-de-sacs  in  the  flexure 
of  the  pastern.  In  this  region  necrosis  is  very  common  as  a  result  of 
suppurating  corns,  or  of  foreign  bodies  having  passed  through  the 
central  zone  in  an  oblique  direction  upwards  and  backwards.  In  operat- 
ing for  such  injuries,  excision  of  the  entire  eschar  would  expose  us  to 
the  risk  of  opening  the  synovial  cul-de-sacs  of  the  pedal  joint  and  of  the 
great  sesamoid  sheath.  Those  of  you  who  have  been  present  at  my 
operations  for  picked-up  nail  know  how  I  proceed  under  such  circum- 
stances. After  removing  all  tissue  which  can  be  taken  away  without 
injuring  these  synovial  sacs,  I  form  a  counter-opening  in  the  flexure  of 
the  pastern.  After  preparing  the  pastern  region,  shaving  away  the 
hair  and  disinfecting  the  skin,  I  introduce  the  special  "sage-leaf" 
shaped  knife  at  the  bottom  of  the  wound  at  the  spot  where  I  have  been 
obliged  to  leave  a  necrotic  or  doubtful  piece  of  tissue,  and  from  this 
point  push  it  upwards  and  backwards  between  the  aponeurosis  and 
plantar  cushion  (keeping  close  to  the  former)  until  it  emerges  above  the 
bulb  of  the  heel.*  If  necessary  I  enlarge  the  opening  by  guiding  the 
knife  along  a  hollow  director.  Then  I  pass  a  piece  of  gauze  to  act  as  a 
drain,  saturate  the  suspected  portion  on  the  stump  of  the  tendon  with 

*   The  procedure  is  precisely  similar  to  that  in  passing  a  frog-seton. — Jno.  A.  W.  D. 


THE    TREATMENT    OF    PICKED-UP    NAIL.  83 

tincture  of  iodine,  and  apply  a  first  dressing,  with  or  or  without  a  shoe. 
If  the  end  of  the  perforans  tendon  does  not  granulate  throughout,  or 
the  necrotic  tissue  fails  to  separate,  drainage  may  be  supplemented  by 
antiseptic  injections  made  through  the  opening  in  the  bend  of  the 
pastern.  Some  months  ago  you  were  able  to  watch  the  progress  of 
two  cases  thus  treated.  They  recovered  without  further  interference. 
I  may  briefly  recapitulate  the  facts  in  connection  with  the  first. 

At  the  commencement  of  last  September  we  received  a  horse 
which  had  picked  up  a  nail  in  the  middle  zone  of  its  off  hind  foot, 
and  had  already  been  twice  operated  on  by  the  veterinar}-  surgeon 
who  sent  it. 

No  weight  was  placed  on  the  foot,  and  the  animal  showed  evidence 
of  frequent  lancinating  pain.  On  examining  the  hoof  the  operative 
wound  in  the  plantar  cushion  was  seen.  Its  deeper  part  formed  a  sinus, 
from  which  discharged  a  considerable  quantity  of  greyish  \-iscous  pus. 
The  aponeurosis  was  necrotic,  and  the  tendon  sheath  had  become  trans- 
formed into  a  suppurating  cavity. 

The  same  day  I  practised  the  complete  operation.  Necrosis  had 
extended  for  a  long  distance  in  the  perforans  tendon,  and  I  N\as  unable, 
without  risking  injury  of  the  synovial  cul-de-sac,  to  remove  the  entire 
mass  of  the  eschar.  I  made  a  counter-opening  in  the  bend  of  the 
pastern,  irrigated  the  wound  with  an  antiseptic  liquid,  inserted  a  gauze 
drainage-tube,  and  then,  with  the  end  of  a  director  en\eloped  in 
wadding,  I  swabbed  with  tincture  of  iodine  that  portion  of  the  tendon 
stump  in  which  I  had  been  obliged  to  leave  a  fragment  of  necrotic 
tissue.  The  parts  were  coxered  with  a  layer  of  iodoform,  the  foot 
enveloped  in  a  large  dressing. 

On  the  four  following  days  the  animal  showed  acute  pain.  During 
the  greater  part  of  the  time  it  remained  lying  down,  and  took  little 
food.  Fever  was  marked,  the  temperature  oscillating  between  39*3° 
and  39*9°  C.  (1027°  and  103*8^  F.). 

On  the  fifth  day  the  dressing  was  renewed.  I  changed  the  gauze 
drain,  again  touched  the  necrotic  portion  of  the  tendon  with  tincture 
of  iodine,  and  applied  a  new  cotton-wool  dressing.  From  the  next  day 
the  condition  improved.  The  appetite  increased,  the  fever  diminished, 
and  the  lancinating  pains  became  less  frequent.  The  impro\ement  was 
continued  on  the  following  days.  Gradually  the  horse  began  to  place 
weight  on  the  affected  limb.  The  dressing  was  allowed  to  remain  until 
the  end  of  the  second  week.  At  that  time  the  wound  was  granulating 
throughout  almost  its  entire  surface,  only  the  navicular  bone  still 
showing  a  small  dry  point.  The  gauze  being  changed,  a  dressing  and 
shoe  were  applied,  and   antiseptic   injections   made  daily  through  the 


84  CLINICAL  vp:terinarv  medicine  and  surgery. 

artificial  sinus.      Still  later  the  dressing  was  changed  each  week,  and 
the  amount  of  gauze  used  as  a  drain  was  diminished. 

At  the  end  of  a  month  weight  was  freely  placed  on  the  limb,  the 
sinus  suppurated  feebly,  and  drainage  was  stopped.  From  this  time 
the  horse  was  exercised  daily.  When  he  left  hospital  at  the  beginning 
of  the  sixth  week  he  walked  almost  sound. 

The  second  patient  entered  hospital  a  short  time  before  the  preceding 
left,  having  been  like  it  unsuccessfully  treated  for  some  time  b}-  the 
colleague  who  finally  sent  it  to  us. 

When  I  examined  the  horse  it  showed  marked  pain,  and  could 
scarcely  bring  the  off  fore-foot  in  contact  with  the  ground.  The 
internal  lacuna  near  the  heel  showed  a  fistulous  wound,  from  which  ran 
a  little  grumous,  stinking  pus.  The  hoof  was  pared  out,  thoroughly 
cleansed  by  immersion  in  a  sublimate  bath,  and  enveloped  in  a  dressing 
of  peat  wool,  the  first  layers  of  which  had  been  moistened  with  an 
antiseptic  solution. 

I  performed  the  complete  operation,  making  the  incision  a  little 
larger  on  the  near  side  by  giving  to  the  transverse  section,  through  the 
plantar  cushion  and  aponeurosis,  an  oblique  direction  backwards  and 
towards  the  inner  heel.  A  few  suspicious  points,  nevertheless,  remained 
on  the  stump  of  the  tendon.  I  made  a  counter-openi'ng  in  the  bend  of 
the  pastern,  inserted  a  gauze  drain,  and  dressed  the  parts  with  tincture 
of  iodine  and  iodoform. 

The  progress  of  the  case  was  practically  similar  to  that  of  the  first. 
Fever  was  a  little  more  prolonged ;  during  the  first  week  the  tempera- 
ture remained  at  39'5°  C.  (io3*i°  F.).  The  animal  had  capricious 
appetite,  placed  little  weight  on  the  limb,  and  frequently  lifted  it  with 
a  jerky  movement,  suggesting  lancinating  pain.  Shortly  after  operation 
an  abscess  developed  in  the  plantar  cushion  in  spite  of  the  drainage. 
Nevertheless  towards  the  fifteenth  day  weight  was  placed  on  the  foot, 
and  improvement  was  afterwards  rapid.  In  the  course  of  the  fourth 
week  a  light  shoe  and  a  dressing,  fixed  in  position  by  splints,  were 
applied. 

Some  days  later  the  animal  began  to  stand  on  the  foot,  and  exercise 
was  commenced  finally.  Drainage  was  stopped  on  the  thirtieth  day. 
A  week  later  the  animal  returned  to  walking  work. 

You  may  remember  another  case  in  which,  when  attempting  to 
remove  the  whole  of  the  dead  part,  I  opened  a  S3'novial  cavity — without 
doubt  that  of  the  large  sesamoid.  A  quantity  of  synovia  ran  from  the 
bottom  of  the  wound,  and  I  was  forced  to  cease  the  operation.     The 


THE    TREATMENT    OF    PICKED-UP    NAIL.  85 

foot  was  dressed  as  in  the  preceding  cases.  The  complication  I  had 
feared  did  not  occur,  but  such  a  good  fortune  must  not  be  anticipated 
when  the  synovial  capsule  is  wounded  in  the  neighbourhood  of  infected 
tissue,  and  by  an  infected  instrument. 

In  conclusion  I  may  say  that,  apart  from  all  operative  accidents, 
extensive  necrosis  of  the  plantar  aponeurosis  constitutes  a  very  grave 
condition.  From  the  economic  standpoint  treatment  is  not  to  be 
recommended  or  undertaken  in  more  than  a  certain  proportion  of  cases, 
and  only  when  the  animals  are  of  value,  or  when  it  is  of  importance  to 
keep  them  alive  irrespective  of  questions  of  cost,  long  duration  of  treat- 
ment, and  uncertainty  of  result. 


XIV.— PLANTAR  NEURECTOMY. 

In  cases  of  obstinate  lameness  you  have  frequently  seen  me  perform 
plantar  neurectomy,  both  above  and  below  the  fetlock,  according  to  the 
seat  and  extent  of  the  morbid  changes  we  are  called  on  to  remedy. 
When  the  lesions  are  limited  to  the  back  part  of  the  foot  I  prefer  the 
low  operation,  reserving  the  other  for  cases  affecting  the  front  or  sides  of 
the  entire  foot,  or  the  coronet  or  pastern.  I  wish  this  morning  to  draw 
your  attention  to  the  advantages  and  drawbacks  of  these  operations, 
and  incidentally  to  clear  up  a  disputed  point  in  their  history. 

Plantar  neurectomy  was  first  conceived  and  performed  by  Moorcroft, 
a  professor  at  the  Veterinary  College  in  London.  At  the  commence- 
ment of  this  century  Moorcroft  made  his  earliest  experiments  on 
section  of  the  plantar  nerves.  He  did  not  publish  his  results  until 
eighteen  years  later.  There  is  no  reason  to  believe  that  Sewell  was  the 
inventor  of  this  operation,  but  he  helped  to  extend  its  use  in  England, 
and  showed  by  numerous  published  cases  the  benefits  to  be  derived 
from  it.  Moorcroft  practised  indifferently  section  or  excision  above  or 
below  the  fetlock.  Sewell  recommended  neurectomy  below  the  fetlock, 
in  order  to  leave  a  certain  degree  of  sensation  in  the  tissues  of  the  foot. 
Blaine  suggested  high  double  neurotomy  for  ringbone.  Coleman  and 
Goodwin  also  studied  neurectomy,  and  reported  a  certain  number  of 
observations  in  support  of  its  efficacy. 

Percival  had  given  a  good  description  of  the  operation  in  his 
lectures,  which  Narcisse  Girard  analysed  in  1824  in  the  first  volume  of 
the  Recueil  de  Mcdecine  VHcrinaire.  From  this  time  the  operation 
began  to  be  practised  in  France.  Its  introduction  was  not  unopposed. 
In  the  discussions  concerning  it  many  objections  were  made,  because 
during  the  period  of  trial  it  had  not  only  given  contradictory  results, 
but  caused  a  considerable  number  of  accidents.  Renault,  Delafond, 
Leblanc,  and  Bouley  helped  to  define  its  field  of  usefulness. 

Neurectomy  is  a  palliative  operation.  Except  in  rare  cases  it  pro- 
duces no  curative  effect ;  it  has  no  direct  influence  on  the  lesions,  nor 
on  the  morbid  processes  for  which  it  is  practised,  but  by  destroying 
sensation  in  the  regions  in  which  these  lesions  and  processes  occur  it 


PLANTAR    NEURECTOMY.  87 

diminishes  or  entirely  removes  the  lameness  for  a  time,  and  thus 
allows  the  animals  to  be  used.  The  duration  of  its  effects  is  very 
variable.  Sometimes  the  lameness  returns  in  a  few  months,  sometimes 
only  after  years.  Cases  occur  when,  for  example,  the  morbid  changes 
have  arrived  at  their  final  stage  of  development,  and  the  inflammation 
which  caused  them  has  ceased,  in  which  it  never  returns. 

From  the  practical  standpoint,  neurectomy  is  a  valuable  operation 
when  performed  with  a  full  knowledge  of  the  state  to  be  treated,  and 
when  judiciously  employed.  Had  it  not  done  signal  service  it  would 
long  ago  have  been  abandoned,  because  it  certainly  entails  the  possi- 
bility of  serious  accidents. 

I  need  only  remind  you  of  the  permanent  weakness  of  the  limb  on 
which  neurectomy  has  been  performed,  the  first  objection  made  to  the 
operation.  After  neurectomy,  it  has  been  said,  movement  of  the  limb  is 
less  assured,  and  the  animal  is  liable  to  stumble  and  fall.  This  must 
be  conceded,  but  such  accidents  only  occur  in  a  small  number  of  cases, 
even  after  high  neurectomy.  Two  Army  Veterinary  Surgeons,  MM. 
Jacoulet  and  Comeny,  who  kept  animals  on  which  they  had  operated 
under  prolonged  observation,  published  cases  showing  that  as  a  general 
rule  neurectomy  does  not  render  troopers  unsafe  to  ride,  nor  prevent 
them  placing  full  weight  on  the  limb.  In  a  large  number  of  my  own 
cases  the  results  have  been  excellent.  Six  years  ago  I  performed  high 
neurectomy  on  the  off  fore-leg  in  an  English  mare,  which  has  since  done 
continuous  saddle  work,  without  ever  showing  the  least  hesitation  in 
the  action  of  the  limb.  From  time  to  time  I  have  seen  a  horse  in 
which  I  performed  low  neurectomy  oa  the  near  fore-leg  four  years  ago. 
It  recovered  perfectly,  has  not  since  gone  lame,  and  has  in  no  way  lost 
control  over  its  movements. 

Another,  much  graver  drawback  is  the  danger  of  inflammatory  and 
trophic  changes  developing  in  the  tissues  formerly  supplied  by  the 
divided  nerve.  These  may  occur  soon  after  operation,  or  ma}-  be 
delayed,  and  usually  end  in  loss  of  the  hoof,  or  rupture  of  the  flexor 
tendons.  Though  comparatively  few  accidents  of  this  kind  have  been 
recorded,  many  have  undoubtedly  happened. 

Sewell,  who  first  practised  high  double  neurectomy,  had  so  many 
complications  of  this  nature  soon  after  operation,  that  he  abandoned 
the  method,  and  practised  low  neurectomy  alone.  Rabouille,  among 
seven  cases,  had  two  of  separation  of  the  hoof.  Renault,  Beugnot, 
Delafosse,  Delafond,  and  Verheyen,  operating  like  the  preceding 
authors  above  the  fetlock,  had  similar  accidents.     Stanley  only  reports 


OO  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

two  cases  in  one  hundred  operations,  and  on  each  occasion  the  compH- 
cation  was  produced  by  an  injury  to  the  foot. 

M.  Nocard,  between  1880  and  1886,  performed  about  one  thousand 
neurectomies  without  a  single  accident.  This  is  practically  the  best 
recorded  series.  M.  Comeny,  who  often  performed  high  double 
neurectomy,  never  saw  after  complications  in  his  patients. 

Benjamin  and  Redon  give  the  history  of  a  horse  in  which  high 
double  neurectomy  was  followed  by  periostosis  of  the  pastern,  obstinate 


Fig.  10. —  Moist  gangrene  of  the  foot  after  plantar  neurectomy  above  the  fetlock. 


ulceration  of  the  skin,  and  other  changes  which  necessitated  slaughter. 
In  one  instance  M.  Jacoulet  saw,  two  months  after  operation,  inflam- 
mation of  the  tissues  of  the  phalanx,  with  enormous  swelling  and 
superficial  ulceration  of  the  skin.  In  a  horse  suffering  from  large  ring- 
bones, which  had  resisted  firing,  M.  Trasbot,  after  unsuccessfully  per- 
forming low  double  neurectomy,  proceeded  to  divide  the  plantar  nerves 
above    the    fetlock.       Three    days    later    the    coronet    became    greatly 


PLANTAR    NEURECTOMY. 


swollen,  and  the  hoof  partially  loosened.  Having  to  treat  a  horse 
affected  with  ringbones,  Palat  performed  high  neurectomy  on  the  side 
of  the  larger  bony  growth,  and  a  fortnight  later  on  the  other  side.  The 
animal  returned  home,  and  continued  working  regularly  for  more  than 
a  year.  During  the  fifteenth  month  swelling  of  the  coronet  and 
separation  of  the  hoof  were  observed  ;  the  animal  had  to  be  slaughtered. 
Hendrickx  reported  three  cases  of  loss  of  the  hoof  after  high  neurectomy. 
In  one  the  accident  was  deferred  more  than  four  years.  Delamotte  and 
Brocheriou  performed  neurectomy  first  below  and  next  above  the  fetlock, 
in  a  mare  suffering  from  navicular  disease  ;  but  the  animal  then  deve- 
loped ringbones,  which  they  treated  by  firing.  Six  weeks  later  the 
hoof  was  shed. 

All  these  cases  refer  to  loss  of  the  hoof  after  high  double  neurectomy, 
but  the  same  complication  may  result  from  section  of  one  of  the  plantar 
nerves  above  the  fetlock. 

Here  is  an  illustration  made  from  a  photograph  showing  the  con- 
dition of  the  near  fore-foot  of  a  horse  in  which,  two  years  before,  I  had 
divided  the  external  plantar  nerve  above  the  fetlock.  A  very  large 
ringbone  existed  on  this  side.  After  five  weeks'  rest  lameness  dis- 
appeared, and  the  animal  was  able  to  resume  work. 

About  six  months  ago  lameness  returned,  and  the  coronet  greatly 
increased  in  size,  in  spite  of  which  the  horse  was  able  to  work  until 
the  commencement  of  the  present  month.  As  the  lameness  and 
swelling  of  the  coronet  had  by  that  time  become  ver}-  marked,  the 
animal  was  left  in  hospital  for  treatment. 

No  weight  was  placed  on  the  near  fore-limb,  which  was  half  fiexed, 
and  from  time  to  time  convulsively  lifted,  suggesting  lancinating  pains. 
The  lower  parts  of  the  limb,  from  the  middle  of  the  forearm,  were 
greatly  swollen.  The  coronet  showed  a  diffuse,  hard,  warm,  slightly 
painful  swelling,  particularly  marked  on  the  outer  side,  at  \\hich  point 
the  thin  upper  edge  of  the  hoof  was  softened  and  detached  from  the 
enlarged  and  inflamed  coronary  band.  All  the  outer  quarter  of  the 
hoof  was  separated.  Along  the  plantar  commissure  the  horn  was 
softened  and  yellowish.  The  strictest  examination  of  the  foot  revealed 
no  recent  injury. 

Treatment  was  by  continued  irrigation,  but  as  the  separation  of  the 
wall  steadily  continued,  and  in  a  few  days  extended  as  far  as  the  toe,  the 
case  was  considered  incurable,  and  the  horse  was  slaughtered. 

On  dissecting  the  foot,  the  skin  and  subcutaneous  connective  tissue 
were  found  greatly  thickened  and  indurated  ;  the  coronar}-  band  was 
double  its  ordinary  size,  and  along  the  entire  external  quarter  the  wall 
was  separated.    The  posterior  branch  of  the  external  plantar  nerve  was 


go  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

atrophied.  On  vertical  section  of  the  hoof,  the  articular  synovial 
membranes  and  the  small  sesamoid  (navicular)  sheath  appeared  in- 
flamed, injected,  and  infiltrated ;  the  synovia  was  scanty  and  reddish 
in  colour.  The  navicular  bone  showed  signs  of  rarefying  ostitis  ;  its 
lower  surface  was  denuded  of  cartilage,  its  compact  tissue  was  under- 
going exfoliation,  and  its  cancellous  tissue  was  hyperaemic  and  friable. 

Softening  and  rupture  of  the  flexor  tendons  may  always  follow 
plantar  neurectomy,  but  are  commonest  when  the  operation  has  been 
performed  for  navicular  disease,  appearing  due  in  part  to  extension  of 
the  disease,  in  part  to  trophic  changes  produced  by  the  operation. 
Among  French  authors,  Renault,  Beugnot,  and  Rabouille  were  the  first 
to  note  this.  In  two  cases  operated  on  by  Rabouille,  rupture  of  the 
tendons  ended  in  the  fetlock  and  the  bulbs  of  the  heel  coming  in  con- 
tact with  the  ground,  the  digit  from  the  fetlock  downwards  lying 
horizontally.  In  both  cases  the  tendons  showed  trophic  changes  in 
the  phalangeal  region,  and  the  perforans  was  completely  ruptured  close 
to  its  insertion  into  the  pedal  bone.  Bouley,  Goubaux,  MM.  Jacoulet, 
Mollereau,  and  many  others  have  seen  similar  cases,  but,  I  repeat,  these 
lesions  occur  where  neurectomy  has  been  performed  for  navicular 
disease,  and  if  the  operation  has  favoured  their  development  it  is  not 
entirely  responsible  for  their  occurrence. 

The  course  taken  by  injuries  affecting  a  neurectomised  foot  varies. 
Bouley  states  that  under  the  influence  of  the  cerebro-spinal  system, 
"healing  inflammation"  proceeds  normally  in  the  parts  affected  by 
neurectomy.  This,  however,  is  not  always  the  case.  You  recently 
saw  a  horse,  unnerved  for  a  large  external  sidebone,  afterwards  develop 
a  quittor  on  the  inner  surface.  In  treating  the  quittor  the  lateral 
cartilage  was  removed,  and  the  subsequent  traumatic  inflammation 
showed  very  special  characters.  The  wound  became  indolent  and 
healed  very  slowly,  while  the  coronet  and  pastern  increased  enormously 
in  size  ;  severe  lameness  continued,  and  the  animal  became  useless. 

The  cases  I  have  just  mentioned,  together  with  others  published 
abroad  and  certain  collected  by  human  surgeons,  show  that  if  removal 
of  nervous  influence  does  not  produce  immediate  and  evident  effects  on 
the  phenomena  of  nutrition,  it  may,  in  combination  with  other  causes, 
like  wounds,  infections,  etc.,  produce  lesions  of  rapid  or  slow  develop- 
ment, and  of  inflammatory,  gangrenous,  hypertrophic,  or  atrophic  nature. 
No  organ  or  tissue,  in  the  region  served  by  the  divided  nerve,  is  safe 
from    these   changes.       They   appear    especially    to    affect    the    skin, 


PLANTAR    NEURECTOMY.  9 1 

connective  tissue,  bones,  and  articulations  ;  and  if,  up  to  the  present, 
their  pathology  is  incompletely  understood,  it  is  known  that  mechanical 
violence  does  not  appear  necessary  for  their  production. 

It  has  been  shown  that  after  section  of  nerves  the  specialised  cells 
of  the  peripheral  end  undergo  retrogressive  changes  eliding  in  destruc- 
tion, and  that  regeneration  occurs  by  a  kind  of  branching  of  the  fibres 
of  the  central  end.  This  reconstitution  of  nerves  explains  the  occasional 
return  of  lameness  after  operation,  and  the  removal  of  this  secondary 
lameness  when  neurectomy  is  again  performed  above  the  point  first 
selected,  Stanley  related  a  case  of  this  kind.  Two  years  after  the 
first  treatment  the  horse  went  lame  and  he  again  operated,  this  time 
above  the  cicatrices  left  by  the  former  intervention.  As  in  the  first 
instance,  the  animal  became  sound. 

But  this  regeneration,  which  occurs  when  only  a  short  portion  of 
the  nerve  has  been  removed,  is  always  somewhat  imperfect.  The 
permanent  good  effects  of  neurectomy,  and  the  delayed  complications 
which  it  sometimes  produces,  are  both  referable  to  this  incomplete 
regrowth.  This  view,  better  than  any  other,  explains  the  lasting  good 
effects  of  neurectomy.  Success  is  due  to  the  fact  that  sensation  only 
returns  to  a  modified  extent  in  the  tissues  from  which  it  has  temporarily 
been  removed.  The  pathogeny  of  the  after  complications,  trophic  or 
otherwise,  is  governed  by  the  same  cause. 

I  conclude  by  reminding  you  that,  on  the  whole,  grave  complica- 
tions after  neurectomy  are  not  frequent,  and  that  even  taking  them  into 
account,  the  practical  value  of  the  operation  remains  indisputable. 
Plantar  neurectomy  has  too  often  given  good  results  to  be  condemned. 
Undoubtedly  it  is  only  a  kind  oi  ultima  ratio,  but  before  abandoning  a 
case  of  lameness  which  has  improved  but  little  or  not  at  all  under  other 
treatment  this  last  resource  should  certainly  be  tried. 


XV.— NEURECTOMY  OF  THE  MEDIAN  AND  OF  THE 
ULNAR  NERVES. 

At  the  present  time  we  have  in  hospital  a  horse  on  which  I  have 
successively  performed  neurectomy  of  the  median  and  of  the  ulnar 
nerve.  To-day  I  intend  to  speak  of  this  horse,  and  of  the  two  opera- 
tions to  which  we  have  been  obliged  to  resort. 

A  little  more  than  a  month  ago — it  was  during  the  first  days  of 
May — M.  H — ,  carman  at  Paris,  brought  a  six-year-old  horse  for 
examination.  It  had  long  been  lame  on  the  off  fore-leg.  On  examin- 
ing the  lower  parts  of  the  leg  I  found  chronic  changes  in  the  bones, 
joints,  and  tendons.  This  examination  showed  the  existence  of  an 
old-standing  strain  of  the  flexor  tendons,  an  indurated  windgall,  pha- 
langeal periostitis,  and  two  sidebones,  the  inner  a  little  larger  than  the 
outer.  Furthermore,  the  fetlock  was  upright  and  had  commenced  to 
knuckle  over.  The  tendon  and  coronet  showed  traces  of  penetrating 
firing.  On  examining  the  limb  the  tendons  appeared  slightly  painful, 
especially  at  their  upper  part  opposite  the  check  ligament.  The 
lameness,  which  was  quite  distinct  at  a  walk,  was  verj'  marked  at  a 
trot. 

M.  H — ,  in  bringing  his  horse,  thought  that  we  would  again  fire 
the  tendon  and  the  ringbones.  I  assured  him  that  firing  would  be  of 
no  benefit.  It  could  certainly  not  cure  all  these  chronic  changes,  nor 
produce  sufficiently  marked  effects  to  remove  the  lameness,  but  as  the 
animal  seemed  worth  it  I  proposed  median  neurectomy,  and  in  your 
presence  explained  on  what  grounds  I  justified  this  method  of  treat- 
ment, which  was  accepted. 

On  the  6th  May,  after  having  applied  thin-heeled  shoes  to  the  fore- 
feet (the  heels  of  which  were  contracted),  I  performed  median  neurec- 
tomy by  the  usual  method.  The  animal  was  cast  on  the  right  side,  and 
the  near  fore-foot  secured  to  the  canon-bone  of  the  corresponding  hind 
limb.  The  hobbles  being  drawn  back,  a  strip  of  webbing  was  applied 
to  the  canon-bone  of  the  off  fore-leg,  which  was  released  from  the 
hobbles  and  drawn  forward  into  a  position  of  full  extension,  in  which  it 
was  secured  by  two  assistants  holding  the  webbing.     In  this  way  the 


NEURECTOMY  OF  THE  MEDIAN  AND  OF  THE  ULNAR  NERVES.        93 

inner  surface  of  the  limb  is  well  uncovered,  and  by  kneeling  in  front  of 
the  chest,  near  the  neck,  the  operator  can  proceed  in  comfort  and  entire 
safety. 


[The  operation  of  median  neurectomy  is  as  follows. 

The  median  nerve  is  readily  discovered  on  the  inner  surface  of  the 
forearm,  running  obliquely  downwards  and  slightl}'  backwards  just 
behind  a  ridge  on  the  head  of  the  radius,  into  which  is  inserted  the 
internal  lateral  ligament  of  the  elbow.  It  crosses  the  posterior  radial 
artery  at  a  very  acute  angle,  and  passes  with  it  towards  the  posterior 
surface  of  the  radius.  The  posterior  radial  vein  (or  veins)  is  situated 
in  front  of  the  nerve.  The  operation  is  performed  opposite  the  lower 
portion  of  the  elbow-joint,  or  immediately  behind  the  upper  extremity 
of  the  radius  towards  the  upper  point  in  the  depression  between  the 
radius  and  the  flexor  muscles  of  the  fore-limb. 

The  skin  having  been  shaven  and  disinfected,  an  incision  about  an 
inch  in  length  is  made,  traversing  successively  the  skin,  subcutaneous 
connective  tissue,  and  the  prolongation  of  the  posterior  superficial 
pectoral  muscle.  Towards  the  lower  angle  of  the  wound  the  fascia  of 
the  forearm  is  slightly  incised,  a  grooved  director  passed  under  it  and 
pushed  upwards,  parallel  with  the  nerve.  By  passing  the  bistour}- 
along  the  groove  the  fascia  is  then  laid  open.  Another  method  consists  in 
using  a  probe-pointed  bistoury.  Certain  operators  even  go  so  far  as  to 
snip  away  with  scissors  an  elliptical  fragment  of  fascia  on  either  side, 
thus  more  freely  uncovering  the  nerve.  The  skin  wound  is  then  held 
open  with  retractors.  The  next  step  in  operation  consists  in  dissecting 
free  the  nerve  (sometimes  a  rather  tiresome  process),  and  raising 
the  nerve  on  a  grooved  director  or  tenaculum.  The  nerve  is  cut 
through  as  high  up  as  possible,  and  again  near  the  lower  limit  of  the 
wound,  a  piece  about  three  quarters  of  an  inch  in  length  being  removed. 
The  operation  is  concluded  by  wiping  the  wound  dry,  dusting  with 
iodoform,  suturing  the  skin,  and  applying  a  little  iodoform  collodion  or 
similar  dressing. — Jno.  A.  W.  D.] 

When  the  incision  is  skilfully  made  at  the  proper  point,  and  the 
antibrachial  aponeurosis  opened,  the  nerve  often  appears  immediately 
as  a  flattened  whitish  cord,  which  has  a  tendency  to  become  thrust 
forward  and  to  protrude  between  the  lips  of  the  incision  in  the  apo- 
neurosis. This  occurred  in  our  horse.  The  operation  only  lasted  a  few 
minutes.  When  the  nerve  does  not  appear,  it  is  usually  sufficient  to 
slightly  alter  the  position  of  the  limb  in  order  to  bring  it  under  the 


94  CLINICAL    VKTERINARY    :^IEDICINE    AND    SURGERY. 

incision ;  for  this  purpose  the  assistants  have  only  to  increase  or 
diminish  the  pull  on  the  limb.  You  know  that  in  certain  animals 
operation  is  rendered  difficult  by  an  abnormal  arrangement  of  the 
radial  veins,  but  this  is  rare.     I  return  to  our  patient. 

After  excising  about  three  quarters  of  an  inch  of  the  nerve  I  placed 
a  fragment  of  gauze  in  the  wound  to  act  as  a  drainage-tube,  and  over  it 
I  united  the  skin  with  a  couple  of  sutures.  On  rising  the  horse 
appeared  a  little  less  lame  than  before  operation.  Next  day  the 
sutures  were  cut,  the  gauze  removed,  and  the  parts  treated  with  anti- 
septic lotions  like  an  open  wound.  Healing  occurred  towards  the  end 
of  the  second  week.  Unfortunately  the  result  was  bad.  Lameness 
was  still  too  marked  for  the  horse  to  work. 

Peters,  and  after  him  others,  showed  that  division  of  the  median 
nerve  alone  may  remove  lameness  resulting  from  bilateral  lesions, — that 
is  to  say,  occupying  both  sides  of  one  of  the  lower  parts  of  the  leg, 
or  encircling  these  regions.  The  results  are  explained  b}'  the  pre- 
ponderating influence  of  the  median  nerve  in  the  innervation  of  struc- 
tures below  the  knee,  a  preponderance  due  to  the  fact  that  at  a  variable 
point  in  the  forearm  the  nerve  terminates  by  di\iding  into  two  branches, 
one  of  which  is  continued  as  the  internal  plantar  nerve,  while  the  other 
joins  the  ulnar  at  the  upper  border  of  the  pisiform  bone,  beneath  the 
tendon  of  the  middle  flexor,  and  is  continued  as  the  external  plantar 
nerve. 

In  hospital  you  have  seen  horses  with  various  chronic  affections, 
like  strained  tendons,  splints,  cartilaginous  ringbones,  and  periostitis  of 
the  phalanges,  in  which  lameness  has  been  removed,  or  certainly  dimin- 
ished, by  dividing  the  median  nerve. 

But  others  occur  in  which  section  of  the  nerve  fails  to  remove  lame- 
ness caused  by  lesions  on  the  outer  side  of  the  limb,  or  at  times  even 
on  the  inner.  The  persistence  of  pain  and  lameness  in  the  latter  case 
is  explained  by  the  existence  of  recurrent  fibres.  Under  such  circum- 
stances, ulnar  neurectomy,  first  practised  by  Vennerholm,  often  proves 
useful.  As,  in  our  patient,  severe  lameness  continued  after  radial 
neurectomy,  division  of  the  ulnar  was  resorted  to. 

Throughout  the  whole  extent  of  the  forearm  the  ulnar  cutaneous 
nerve,  accompanied  by  the  ulnar  artery  and  vein,  is  situate  between 
the  oblique  and  external  flexors  of  the  metacarpus,  and  immediately 
under  the  fascia  uniting  them.  By  palpation  with  the  finger  tips  the 
muscular  interspace  which  fixes  the  line  of  operation  is  readily  dis- 
covered. 


NEURECTOMY    OF    THE    MEDIAN    AND    OF    THE    ULNAR    NERVES. 


95 


In  performing  this  operation  the  horse  is  cast  on  the  sound  side. 
The  affected  limb  is  left  in  the  hobbles,  but  drawn  tense  by  means  of 
two  strips  of  webbing,  one  fixed  on  the  upper  portion  of  the  canon- 
bone  being  pulled  backwards,  the  other,  attached  to  the  coronet,  in  a 
forward  direction.  Two  assistants,  holding  the  free  ends,  keep  the 
parts  steady. 

The  operator  kneels  in  front  of  the  upper  part  of  the  forearm  ;  the 
point  selected  is  four  to  six  inches  above  the  knee. 

The  parts  having  been  prepared,  my  colleague  M.  Almy  made,  at 
the  point  just  indicated,  an  incision  about  one  inch  and  a  quarter  to 


Figs,  ii  and  12. — Neurectomy  of  the  ulnar  nerve.    F  E,  flexor  metacarpi  externus  ;   F  O, 
flexor  metacarpi  obliquus  ;   N,  ulnar  nerve  ;  A  V,  ulnar  artery  and  nerve. 

one  inch  and  a  half  long  through  the  skin.  He  then  divided  the  sub- 
cutaneous connective  tissue,  the  antibrachial  aponeurosis,  and  the 
fascia  which  unites  the  aponeurotic  covering  of  the  two  muscles. 

With  forceps  and  bistoury  he  dissected  away  the  connective  tissue 
surrounding  the  nerve,  following  the  direction  of  the  wound,  and  care- 
fully avoiding  injury  to  the  ulnar  artery  and  vein  which  accompany  the 
nerve. 

Having  isolated  the  nerve,  he  divided  it  at  the  upper  angle  of  the 
wound,  and  excised  a  fragment  about  one  inch  and  a  quarter  in  length. 


96  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

The  wound  was  cleansed  and  the  skin  brought  together  with  three 
small  sutures. 

The  results  of  this  second  operation  were  satisfactory.  On  rising 
the  horse  no  longer  w^alked  lame.  The  wound  healed  by  first  intention. 
At  the  present  moment  the  animal  is  exercised  night  and  morning. 
At  a  trot  it  only  shows  trifling  lameness,  and  as  it  is  used  for  heavy 
draught  it  will  soon  be  able  to  return  to  work, 

I  shall  recommend  the  owner  to  keep  careful  watch  over  the  con- 
dition of  the  foot  and  of  lower  parts  of  the  limb.  We  must  bear  in 
mind  the  possibility  of  trophic  changes  and  of  sloughing,  which  I 
referred  to  when  treating  of  plantar  neurectomy. 

You  will  not  often  see  this  double  neurectomy  performed.  Even 
neurectomy  of  the  median  alone  often  has  serious  drawbacks.  It  should 
be  reserved,  as  I  have  already  said,  for  old-standing  chronic  affections 
of  the  fore-limb,  and — particularly  in  dealing  with  valuable  animals — 
should  not  be  tried  until  all  other  methods  of  treatment,  especially 
firing,  have  proved  unsuccessful. 

I  do  not  agree  with  the  advice  of  the  savant  who  recommended  it 
for  all  cases  of  strained  tendon  uncured  at  the  end  of  six  weeks.  That 
would  have  ended  in  a  perfect  debauch  of  neurectomy. 


XVI.— LYMPHANGITIS  AND  MULTIPLE  ABSCESSES  IN 
THE  HORSE,  DUE  TO  THE  PRESENCE  OF 
STAPHYLOCOCCI. 

In  explaining  to  you  the  modern  doctrine  of  suppuration,  I  stated 
that  all  suppuration  seen  in  our  patients  is  the  work  of  certain  mi- 
crobes, chief  aniongst  which  are  the  Staphylococcus  albiis  and  aureus  and 
the  streptococci — other  varieties  occurring  much  less  frequently.  The 
microbes  enter  the  tissues  by  many  paths,  the  commonest  being 
cutaneous  or  mucous  wounds.  Very  trifling  abrasions,  often  con- 
cealed by  the  hair  and  practically  imperceptible,  may  serve  as  points 
of  entry.  Sometimes  they  simply  produce  a  local  abscess,  at  others 
they  enter  the  lymph  channels,  causing  lymphangitis  or  abscess  forma- 
tion in  neighbouring  or  far-removed  lymphatic  glands,  according  to 
the  condition  of  the  lymph  channels.  Occasionally  they  enter  the 
circulation,  are  swept  along  by  the  blood,  and  give  rise  to  varying 
mischief,  according  to  their  degree  of  virulence.  In  this  way  strepto- 
cocci and  staphylococci  produce  the  metastatic  abscesses  of  pyaemia, 
and  the  microbe  of  strangles  induces  the  majority  of  abscesses  seen 
during  the  course  of  this  disease. 

In  my  part  of  the  hospital  you  have  seen  two  horses  in  which 
staphylococci  have  thus  caused  abscesses  in  different  parts. 

Some  months  ago  a  seven-year-old  Percheron  horse,  in  which  I 
had  removed  the  lateral  cartilage  of  the  off  fore-foot  on  account  of 
quittor,  showed  four  days  after  operation  very  marked  swelling  of  the 
limb,  especially  pronounced  below  the  knee — a  swelling  which  ex- 
tended to  the  forearm,  and  caused  me  to  fear  the  existence  of  deep- 
seated  abscess  in  this  region.  All  danger  of  immediate  complications 
vv^as  however  removed  by  the  use  of  warm  antiseptic  baths,  iollowed 
by  iodoform  dressings  ;  the  operation  wound  healed  steadily,  swelling 
of  the  limb  at  the  same  time  diminishing. 

The  lymphangitis  had  completely  disappeared  when  a  fortnight 
later  we  discovered  a  number  of  small  abscesses 'scattered  about  tlfe 
neck,    sides,    and    limbs.       Of    what    nature    were    these    abscesses  ? 


go  CLINICAL    Vf:TERINAKV    MKDICINE    AND    SURfJERV. 

Although  there  was  no  clinical  sign  pointing  to  farcy  the  animal  was 
injected  with  mallein.  The  result  was  as  I  had  foreseen  ;  no  local 
reaction  followed,  and  the  temperature  rose  only  half  a  degree.  I  had 
collected  with  the  usual  precautions  some  pus  for  bacteriological 
examination  and  cultivations.  The  microscope  revealed  a  few  staphy- 
lococci, and  the  tubes  of  gelatine  which  we  sowed  gave  a  pure  culture 
of  the  Staphylococcus  albiis. 

Treated  by  injections  of  dilute  sublimate  solution  the  abscesses 
rapidly  healed.  No  others  formed.  The  animal's  general  health  was 
excellent,  and  to  explain  the  production  of  these  multiple  abscesses 
I  see  no  other  possible  hypothesis  than  infection  of  the  blood  by 
some  pyogenic  microbe  which  had  multiplied  in  the  wound  in 
the  foot  and  given  rise  to  the  lymphangitis.  Against  that  may  be 
urged  the  time  ^^•hich  elapsed  between  the  acute  phase  of  the  hmph- 
angitis  and  the  appearance  of  the  abscesses,  but  well-established  facts 
show  that  secondary  suppurative  lesions  may  occur  after  a  much 
longer  time.  Many  other  microbes  besides  staphylococci  may  cause 
disturbance  after  remaining  dormant  for  weeks,  months,  or  even 
years. 

The  second  case  is  not  less  interesting  than  the  first,  and  shows 
like  it  that  the  Staphylococcus  alhus  ma}-  be  the  sole  cause  of  secondary 
abscesses  developing  far  from  the  primar}-  centre.  A  fifteen-year-old 
Percheron  mare  suffering  from  circumscribed  gangrenous  inflammation 
on  the  near  fore-pastern  was  received  into  hospital  on  the  6th  December, 
1895.  The  eschar  was  removed,  and  the  wound  appeared  about  to 
heal  when  diffuse  lymphangitis  extended  throughout  the  limb,  the 
swelling  became  enormous,  sensibility  excessive,  and  interference  with 
movement  ver}-  marked.  The  first  abscess  formed  on  the  inner  surface 
of  the  knee,  and  opened  spontaneously.  During  the  next  few  days  the 
wound  on  the  pastern  presented  a  less  favourable  appearance  ;  it  dis- 
charged freel}- ;  its  margins  were  swollen  and  painful.  The  swelling 
next  invaded  the  upper  portions  of  the  limb,  extending  as  high  as  the 
shoulder.  Soon  afterwards  the  hair  was  shed  over  a  line  extending 
from  the  wound  on  the  knee.  On  this  line,  which  corresponded  to  the 
course  of  the  inflamed  lymphatics,  five  subcutaneous  abscesses  deve- 
loped;- and  were  opened  in  succession.  Close  to  the  point  of  the 
shoulder  was  a  circular  swelling,  denuded  of  hair,  and  measuring  an 
inch  or  more  in  diameter,  produced  by  another  superficial  abscess. 

The  wound  on  the  knee,  circular  in  form,  and  as  large  as  a  florin, 
became  covered  with  firm  health3--looking  granulations.  Its  margins 
projected  slightly  above  the  surrounding  skin,  and  its  centre  showed  a 


LV.MPHAN(.;iTIS    AND    iMlT.TIFI.K    Al'.SCESSES    IN    THE    HORSE.  99 

sinus  which  communicated  with  a  subcutaneous  conduit  exactly  corre- 
sponding with  the  depilated  line  aboxe  mentioned.  It  discharged 
whitish,  thin,  slightly  viscous  pus,  similar  in  character  to  that  always 
formed  in  lymphatic  vessels  or  glands.  The  lower  parts  of  the  limb 
showed  relativel}-  little  cedematous  swelling.  The  wound  on  the 
pastern  was  about  two  and  a  half  to  two  and  three  quarter  inches  long, 
and  half  an  inch  across. . 

These  wounds  had  no  resemblance  to  ulcers,  and  neither  they  nor 
the  lymphatic  vessels  were  surrounded  by  much  induration.  The 
animal  had  not  suffered  from  any  disease  for  years,  and  its  general 
condition  was  excellent. 

For  the  purpose  of  bacteriological  examination  I  punctured  an 
abscess  on  the  inner  surface  of  the  forearm,  and  with  a  sterilised 
pipette  collected  a  little  pus,  which  I  sowed  on  gelatine  and  potato. 
At  the  temperature  of  the  lecture  room  colonies  of  Staphylocvccus  albiis 
developed. 

The  clinical  course  of  these  lesions  differed  from  those  usually  seen 
in  glanders.  An  injection  of  mallein  produced  a  very  trifling  reaction. 
After  puncturing  the  abscesses  treatment  consisted  in  antiseptic  injec- 
tions into  the  sinus.  On  the  i6th  December  the  swelling  and  wounds 
on  the  near  fore-limb  still  showed  the  same  characters. 

On  the  i8th  we  discovered  on  the  outside  of  the  right  thigh,  a 
little  behind  and  above  the  patella,  a  hot,  sensitive  cedematous 
swelling,  the  centre  of  which  showed  fluctuation.  It  was  punctured 
aseptically,  and  some  pus  collected  for  cultivation.  The  cultures  gave 
colonies  of  the  same  staphylococcus.  The  animal  received  daily  in  its 
food  one  and  a  half  ounces  of  bicarbonate  of  soda  in  the  morning,  and 
two  and  a  half  drachms  of  sulphate  of  quinine  at  night. 

On  the  20th  December  a  warm,  painful  swelling  was  noted  in  the 
region  of  the  extensor  muscles  of  the  right  forearm,  suggesting  the 
formation  of  an  abscess.  Next  day  (edematous  enlargement  appeared 
below  the  elbow,  examination  of  which  revealed  the  presence  of 
fluctuation  in  the  depths.  The  abscess  was  punctured  and  some  of 
the  pus  sown  on  gelatine  and  potato.  The  Staphylococcus  alhus  was 
again  found  to  be  the  only  micro-organism  present. 

Finally,  eight  days  later,  a  fresh  suppurating  centre,  also  produced 
by  the  same  microbe,  formed  on  the  right  side  of  the  neck. 

The  wounds  having  healed  and  the  lymphangitis  disappeared,  the 
horse  returned  to  ordinary  work.  It  has  not  since  been  seen  ;  but  some 
months  later  we  were  told  that  it  had  not  developed  any  further 
abscesses,  its  svstem,  therefore,  appeared  to  have  become  entirely 
free  from  staphylococci. 


XVII.— EXTERNAL  TUBERCULOSIS  IN  THE  DOG 

AND  CAT. 

You  know  that  tuberculous  dogs  may  eject  material  containing 
bacilli  by  the  nose,  anus,  and  urethra.  To-day  I  purpose  showing  you 
that  some  also  distribute  the  virus  by  external  lesions,  the  specific 
character  of  which  has  been  overlooked,  lesions  which  may  persist  for 
a  long  time,  and  discharge  pus  rich  in  bacilli.  I  shall  take  as  my 
subject  tuberculous  wounds  and  sinuses.  The  region  of  the  neck  is 
that  most  commonly  affected.  I  have  seen  wounds  of  this  kind  in 
fourteen  patients  ;  in  twelve  they  were  situated  at  varying  points  on 
the  anterior  margin  of  the  neck  ;  in  one  the  thoracic  wall  showed  a 
sinus,  and  in  the  last  the  wound  was  close  to  a  joint. 

To  show  you  the  danger  of  such  lesions  conveying  the  disease,  I 
shall  briefly  describe  three  cases  from  among  those  which  I  have 
investigated. 

On  the  2ist  May,  1895,  a  two-year-old  poodle,  belonging  to  M. 
V — ,  Avenue  du  Maine,  Paris,  was  brought  for  examination.  At  the 
beginning  of  March,  in  the  same  }ear,  this  dog  had  had  an  abscess  at 
the  upper  part  of  the  neck.  The  wound,  produced  by  puncture,  instead 
of  healing  had  become  ulcerous,  and  the  animal  had  lost  flesh  to  a 
marked  degree. 

When  I  examined  the  patient  the  front  of  the  neck  displayed  a 
large  ulcer  with  thin  margins,  separated  from  the  skin  to  a  consider- 
able extent,  bathed  in  greyish  pus,  and  with  a  granular  base,  pene- 
trated by  a  number  of  sinuses  running  toward  the  larynx  and  origin  of 
the  trachea.  The  animal's  thin  condition  and  the  appearance  of  the 
wound  immediately  suggested  tuberculosis.  Bacteriological  examina- 
tion of  the  pus  revealed  numerous  bacilli.  This  poodle  lived  in  the 
suite  of  rooms  occupied  by  its  owners.  The  lesion  in  the  neck  having 
been  regarded  as  a  simple  wound  had  been  unsuccessfully  treated  for 
two  months  with  all  kinds  of  applications,  and  had  even  been  sutured. 


EXTERNAL    TUBERCULOSIS    IN    THE    DOU.    AND    CAT. 


Fig.  u?. — Tuberculous  ulcer  in  the  throat. 


Fig.  14. — Tuberculous  ulcer  in  the  neck. 


I02  CLINICAL    VETERINARY    :\IEDICINE    AND    SURCERY. 

On  the  23rd  July,  1895,  a  small  bitch  belonging  to  M,  L — ,  Rue  de 
Charenton,  Paris,  was  brought  for  examination. 

For  about  six  weeks  this  bitch  had  shown,  nearly  over  the  centre 
line  of  the  front  of  the  neck,  two  sinuous  wounds.  During  the  journey 
from  Paris  to  Alfort  the  child  who  brought  it  had  bandaged  the  animal's 
neck  with  her  handkerchief,  and  in  our  presence  she  wiped  away  the 
pus  running  from  the  wounds  with  this  same  handkerchief. 

The  appearance  of  the  wounds,  the  thinness  of  the  patient,  and  the 
dyspnoea,  awakened  suspicion  of  tuberculosis.  I  made  co\'er-glass  pre- 
parations with  the  pus  ;  all  contained  bacilli. 

This  animal  was  left,  and  kept  in  the  stable  belonging  to  the  surgical 
clinique.  Five  months  later  it  died  from  generalised  tuberculosis. 
The  sinuses  never  healed. 

On  the  i6th  May  last,  M.  H — -,  living  in  the  Rue  St.  Martin,  Paris, 
brought  us  a  four-3'ear-old  dog,  which  had  suffered  for  three  months 
from  an  ulcerous  wound  one  and  a  quarter  inches  in  length  and  three 
quarters  of  an  inch  in  width  about  the  middle  of  the  neck.  The  margins 
were  separated  from  the  skin,  eroded,  and  covered  with  crusts  and 
blood-stained  pus.  Four  inches  below  this  lesion  was  a  slender  sinus 
masked  by  the  agglutinated  hair.  As  in  the  cases  just  mentioned,  pus 
from  these  lesions  was  found  to  contain  large  numbers  of  bacilli. 

Until  the  day  it  was  brought  to  Alfort  this  dog  lived  in  a  corner  of 
the  single  room  inhabited  by  M.  M — ,  his  wife,  and  their  child. 

These  tuberculous  wounds  of  the  neck  are  of  lymphatic  origin. 
Only  one  case  had  been  published  pre\ious  to  my  researches,  and  the 
author,  Miiller  of  Dresden,  regarded  the  case  as  of  primary  cutaneous 
origin.  I  have  been  able  to  follow  the  development  in  several  subjects. 
It  is  similar  to  that  of  tuberculous  suppurating  adenitis  in  man,  and 
exhibits  three  principal  stages:  (i)  Glandular  disease;  (2)  Abscess 
formation  in,  or  around  a  lymphatic  gland  ;  (3)  Ulceration  of  the  skin. 
When  a  lesion  of  this  kind  is  fully  developed,  or  has  existed  for  some 
weeks,  it  usually  presents  the  following  appearance  :  A  circular,  oval, 
or  irregular  wound,  the  margins  of  which  are  denuded  of  hair,  torn  or 
thinned,  and  separated  from  the  subjacent  tissues;  with  reddish, 
uneven  base  covered  with  indolent  granulations,  or  dotted  over  with 
yellowish  points,  from  which  sinuous  tracts  lead  towards  the  trachea, 
or  along  the  line  of  adjacent  vessels.  The  wound  discharges  greyish 
or  blood-stained  pus,  always  purulent,  and  sometimes  rich  in  bacilli. 

Their  true  nature  not  being  recognised,  these  lesions  are  treated 
like  simple  wounds;  they  continue  to  suppurate.      In  certain  patients 


EXTERNAL    TUBERCULOSIS    IN    THE    llOci    AND    CAT.  I03 

the  cutaneous  ulcer  contracts ;  in  others  it  gradually  increases. 
Abscesses  sometimes  develop  in  the  neighbourhood  and  open  externally, 
producing  small  wounds,  which  may  unite  with  the  first ;  sometimes 
the  skin  becomes  separated  from  subjacent  structures  over  a  large  area, 
and  is  rapidly  riddled  with  ulcers.  The  muscular  and  connective  tissues 
traversed  by  the  sinuses  are  inflamed,  hardened,  and  fused  together. 
On  dissection  granulations  and  caseous  tubercles  are  found.  The 
retro-pharyngeal  and  cervical  lymphatic  glands  are  always  affected  ; 
either  they  are  hypertrophied,  inflamed,  and  on  section  appear  dotted 
over  with  yellowish  points  formed  by  the  granulations,  or  they  appear 
as  little  swellings  the  size  of  a  haricot  bean  or  a  hazel  nut,  with 
softened  purulent  centres.  I  have  twice  seen  the  cervical  glands 
connected  by  knotted  lymphatic  vessels  with  the  tracheo-bronchial 
lymphatic  glands. 

The  mucous  membranes  in  the  domain  of  the  affected  lymphatics 
rarely  show  specific  lesions.  I  have  only  seen  three  such.  One  showed 
tuberculous  ulceration  of  the  left  tonsil ;  another,  a  submucous  tubercle 
in  the  pharvnx  ;  and  the  third,  ulceration  of  the  mucous  membrane  of 
the  larynx. 

Despite  the  very  rare  occurrence  of  lesions  indicating  the  point  of 
entrance  of  bacilli,  these  tuberculous  ulcers  of  the  neck  result  from 
auto-inoculation  of  the  pharyngeal,  laryngeal,  or  nasal  mucous  mem- 
branes, by  purulent  products  formed  in  the  lung  and  coughed  into  the 
pharynx  or  posterior  nasal  cavities.  Of  the  above-mentioned  twelve 
patients  showing  tuberculous  ulcer  of  the  neck  ten  had  very  marked 
disease  of  the  lungs,  which  were  partially  destroyed  by  the  formation 
of  cavernous  spaces.  Pharyngeal  catarrh  is  known  to  be  fairly  common 
in  the  dog.  Under  these  circumstances  auto-inoculation  occurs  readily. 
The  mucous  membrane,  whether  normal  or  deprived  of  its  epithelium, 
when  covered  with  virulent  muco-pus  is  penetrated  by  the  bacilli, 
which  afterwards  extend  to  the  neighbouring  lymphatic  glands.  Pres- 
sure of  the  collar  causes  inflammation  of  the  infected  glands,  favours 
suppuration  of  the  surrounding  tissues,  and  ulceration  of  the  skin. 
This  is  the  true  pathogeny  of  tuberculous  ulcers  in  the  dog's  neck. 

Subcutaneous  or  <jpen  tuberculous  lesions  are  also  seen  in  the  cat. 
In  addition  to  the  three  cases  of  this  nature  mentioned  I  may  cite  the 
two  following  : 

At  the  beginning  of  April,  1895,  a  seven-year-old  female  cat  was 
brought  to  the  clinique.  It  had  been  ill  for  some  time,  and  already 
showed  marked  wasting.  The  owner  had  particularly  noted  difficulty 
in  breathing,  attacks  of  coughing,  and  at   certain   times  a  little  nasal 


I04 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


discharge.  Although  the  Eippetite  \vas  sometimes  capricious,  the  animal 
usually  ate  the  greater  part  of  its  food.  It  belonged  to  a  woman  \vho 
had  long  suffered  from  chronic  cough,  Nvhich  she  regarded  as  asthmatic, 
though  to  a  better-informed  person  she  clearly  had  the  appearance  of  a 
consumptive.  About  six  weeks  before  a  suppurating  wound  had  been 
noticed  at  the  upper  part  of  the  cat's  neck.  Situated  near  the  origin 
of  the  trachea,  this  wound  ^^•as  circular  in  form,  hardly  two  lines  in 
diameter,  and  had  thin  separated  edges.  It  communicated  with  a  long 
sinuous  track,  ending  on  the  left  surface  of  the  trachea.     It  discharged 


^^^^ 


J^c--^'^^ 


Y\Q.  15. — Tuberculous  ulrer  of  the  nose. 

a  greyish  pus,  in  which  bacilli  were  discovered  on  bacteriological  exami- 
nation. I  was  unable  to  prevail  on  the  owner  to  leave  this  cat,  and  it 
was  never  broucht  back  acain. 


A  year  later,  in  1896,  a  three-year-old  cat  was  brought  for  examina- 
tion whilst  still  in  good  health.  For  five  or  six  months  it  had  suffered 
from  an  ulcerous  wound  of  the  nose  and  face. 

I  kept  this  patient  in  hospital  for  some  time.  The  wound  was 
rounded  in  form,  occupied  the  entire  dorsal  region  of  the  nose  and  a  por- 
tion of  the  face  and  forehead,  and  measured  nearly  an  inch  and  a  half  in 
diameter.      Its  margins  were  indurated  and  excavated  perpendicularly. 


EXTERNAL  TUBERCULOSIS  IN  THE  DOG  AN!)  CAT.  105 

Its  base  was  greyish,  fairly  level,  and  presented  the  general  appearance 
of  an  ulcerated  cancer.  Yellowish  granulations,  however,  appeared  at 
points  ;  and  around  its  outer  edge,  beneath  the  separated  skin,  caseous 
material  could  be  seen.  Greyish  pus  ran  from  the  nostrils,  which  were 
soiled  and  covered  with  crusts.  Both  submaxillar)-  lymphatic  glands 
were  slightl}-  enlarged.  The  lesion  was,  therefore,  of  tuberculous 
character,  and  ver}-  virulent.  The  nasal  discharge,  pus,  and  caseous 
material  from  the  wound  contained  considerable  numbers  of  bacilli. 

On  post-nwrtcm  examination  we  found  disease  of  the  precaecal 
mesenteric  glands,  which  were  as  large  as  a  hazel  nut,  hard,  gritty  on 
section,  and  showed  caseous,  and  even  chalky,  points.  The  liver  also 
presented  some  tubercles.  The  lungs  contained  numerous  caseous 
centres ;  the  tracheo-bronchial,  retro-pharyngeal,  and  submaxillary 
glands  were  diseased. 

The  ulcer  on  the  nose  had  not  only  destroyed  the  soft  tissues,  but 
had  invaded  the  subjacent  bone,  which  was  soft  and  friable,  eroded  in 
places,  and  infiltrated  with  caseous  material.  The  upper  wall  of  the 
nasal  cavities  was,  however,  only  pierced  at  one  point,  between  the 
nasal  and  superior  maxillary  bones,  midway  between  the  eye  and  base 
of  the  nose,  whence  communication  existed  with  the  left  nasal  cavity 
by  an  orifice  which  had  escaped  notice  during  life.  For  a  distance  of 
about  three  eighths  of  an  inch  around  the  ulcer,  the  skin  and  sub- 
cutaneous connective  tissue  showed  on  section  yellowish  points  de- 
noting softened  tubercles.  In  the  thickness  of  the  end  of  the  nose 
similar  lesions  ^^■ere  found.  Close  to  the  perforation,  and  particularly 
over  the  turbinated  bones,  the  pituitary  membrane  was  thickened, 
ulcerated  in  places,  and  covered  with  fine  tuberculous  granules  ;  thick- 
ening of  the  mucous  membrane  was  specially  marked  towards  the 
opening  of  the  nostrils,  which  it  partially  blocked. 

Ulceration  of  the  tissues  of  the  nose  was  probably  secondary  ;  a 
centre  having  first  formed  on  the  pituitary  membrane,  extended  to  the 
turbinated  bones,  thence  to  the  lower  portion  of  the  nasal  bones,  and 
lastly  to  the  skin.  The  process  would  be  favoured  by  rubbing  or 
scratching  the  parts.  It  is  also  possible  that  the  skin  may  have  been 
directly  inoculated  by  the  action  of  the  paws. 


XVIIL— A  CASE  OF  SARCOMATOUS  DISEASE. 

During  the  past  month  you  have  had  opportunities  of  following  in 
hospital  the  progress  of  a  rare  form  of  sarcomatous  disease  in  the  horse, 
distinguished  by  its  clinical  characters  from  the  varieties  hitherto 
described  in  animals.  In  our  patient  development  of  the  disease  was 
indicated  by  the  appearance  of  numerous  tumours  of  varying  size  in 
the  subcutaneous  connective  tissue  and  muscular  interstices,  without 
the  skin  or  lymphatic  glands  being  invaded,  as  is  the  rule  in  sarcoma, 
and,  until  the  last  few  days  at  least,  without  grave  symptoms  pointing 
to  the  existence  of  visceral  new  growths  having  occurred. 

Sarcomata  have  a  marked  preference  for  the  connective  tissue. 
They  may  occur  wherever  this  tissue  exists,  i.e.  in  all  organs.  The 
majority  have  a  well-marked  tendency  to  generalisation.  This  process, 
which  occurs  by  the  venous  channels,  is  often  very  irregular.  Secon- 
dary tumours  sometimes  develop  in  large  numbers  in  almost  all  the 
viscera;  sometimes  they  are  comparatively  rare.  The  lung  is  most 
frequently  invaded  when  infection  is  general,  and  usually  shows  the 
greatest  number  of  growths.  Cases  occur,  however,  where  sarcomata 
appear  to  extend  systematically,  affecting  almost  exclusively  the  bones, 
skin,  or  subcutaneous  connective  tissue,  and  producing  particular 
varieties  of  disease,  distinguished  by  special  clinical  and  anatomical 
pathological  characters. 

Thirty  years  ago  Kaposi  described,  under  the  name  of  cutaneous 
sarcoma,  a  human  disease  characterised  by  circumscribed  swellings  of 
the  skin,  raised  patches,  and  flattened,  isolated,  or  confluent  swellings, 
the  structure  of  which  was  that  of  sarcoma.  A  similar  aftection  occurs 
in  animals.  M.  Trasbot  described  it  in  the  article  on  Sarcoma  in  the 
Didionnaivc  dc  Mcdccinc  Vctcvinairc,  under  the  title  "  Varietes  Ver- 
ruqueuses."'  In  solipeds,  says  M.  Trasbot,  this  variety  is  confined  to 
surfaces  where  the  skin  is  fine — around  the  eyes,  nose,  mouth,  ears, 
sheath,  and  mammary  gland,  and  on  the  inner  surfaces  of  the  limbs  ; 
sometimes  it  invades  the  abdominal,  thoracic,  and  inferior  cervical 
regions.  The  tumours  may  assume  one  of  two  forms,  appearing  either 
as  warts  adherent  to  and  projecting,  more  or  less,  above  the  surface  of 
the  skin,  or  as  globular  masses  lodged  in  tne  subcutaneous  connective 


A    CASK    OF    SARCOMATOUS    DISEASE.  I07 

tissue  ;  both  forms,  however,  are  always  associated  in  the  same  subject. 
The  tissue  of  these  new  growths  is  pale  grey,  without  marbling,  is 
firmer  and  denser  than  that  of  other  sarcomata,  and  is  composed  ex- 
clusively of  fusiform  cells.      Round-cells  never  occur. 

Such  were  not  the  clinical  or  anatomical  features  of  the  disease  in 
our  patient.  The  skin  was  altogether  unaffected  :  the  tumours  were 
dispersed  throughout  the  subcutaneous  and  intra-muscular  connective 
tissue  ;  only  a  few  adhered  to  the  skin,  and  even  they  did  not  penetrate 
it.  Moreover  post-mortem  examination  showed  much  more  extensive 
visceral  lesions  than  we  had  anticipated.  The  visceral  lesions  pre- 
-ceded  those  in  the  subcutaneous  connective  tissue,  but  we  were  unable 
to  make  out  any  close  connection  between  the  subcutaneous  and  the 
visceral  tumours  from  the  point  of  view  of  their  origin.  No  vascular 
lesions  existed  to  explain  the  generalisation. 

The  patient  died  at  the  commencement  of  the  sixth  week  after 
admission  to  hospital.  I  wish  to  remind  you  of  its  history.  The 
report  of  the  post-inortciit  examination  leaves  no  room  for  wonder  at 
the  animal's  death. 

A  Dutch  gelding,  about  twelve  years  old,  in  fairly  good  condition. 
Sent  to  the  College  on  account  of  subcutaneous  swellings  in  different 
regions.  The  largest  was  situated  on  the  right  side  of  the  chest, 
opposite  the  fourth,  fifth,  and  sixth  ribs,  a  little  above  the  line  of  the 
elbow.  Hemispherical  in  form,  it  measured  nearly  six  inches  in 
diameter.  Another  of  about  the  same  size  lay  immediately  in  front  of 
the  cervical  angle  of  the  scapula.  A  third,  as  large  as  a  fowl's  eg^> 
was  noted  about  halfway  up  the  left  side  of  the  chest,  opposite  the 
sixth  rib.  At  the  lowest  part  of  the  same  side  of  the  chest,  opposite 
the  twelfth  rib,  was  a  nodule  the  size  of  a  nut.  On  the  left  side  again, 
over  the  thirteenth  rib,  was  a  tumour  as  large  as  a  pigeon's  egg.  All 
were  practically  of  the  same  character,  being  firm,  slightly  elastic, 
painless,  sharply  defined,  moveable  under  the  skin  and  over  the  sub- 
jacent parts,  or  in  cases  slightly  adherent  to  the  latter. 

The  temperature,  respiration,  and  circulation  were  normal.  The 
urine  showed  considerable  sediment,  consisting  largely  of  carbonate 
and  phosphate  of  lime,  but  contained  no  albumen,  sugar,  or  bile  pig- 
ments.    There  \vas  no  change  in  the  proportion  of  urea. 

The  blood  was  normal.  The  number  of  blood-corpuscles  was  found 
to  be  as  follows  : 

Red  corpuscles     .  .  .     5,602,875  per  cubic  millimetre. 

White  corpuscles  .         .  5864  ,,  ,, 

Proportion   .  .  .  .      i  to  955. 


Io8  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

This  horse  was  sent  to  us  b)-  a  colleague,  who  regarded  it  as  suffer- 
ing from  "cold  abscesses."  But  subcutaneous  cold  abscesses  are  less 
sharply  defined  than  were  the  tumours  ;  the}'  grow  more  rapidl}-,  are 
adherent  to  the  skin,  and  pressure  on  them  produces  pain  ;  finally, 
they  are  usually  found  in  parts  covered  by  the  harness.  Exploratory 
puncture  through  the  centre  of  the  two  largest  swellings  gave  a  nega- 
tive result. 

We  began  to  consider  whether  the  case  was  one  of  tuberculosis. 
There  was  no  enlargement  of  the  glands  at  the  entrance  of  the  chest, 
in  the  groin,,  or  under  the  lumbar  vertebrae.  On  the  supposition  of 
tuberculosis  some  at  least  of  these  swellings  should  have  been  accom- 
panied by  lymphangitis  and  by  specific  inflammation  of  lymphatic 
glands,  as  in  the  case  of  which  I  recently  spoke.  We  cleared  up 
this  question,  however,  by  testing  with  tuberculin,  by  bacteriological 
examination,  and  by  inoculation. 

One  of  the  tumours  was  removed  from  the  right  side  of  the  chest. 
It  was  flattened,  circular  in  form,  and  its  tissue  greyish-white,  and 
slightly  firm.  Microscopic  examination  showed  it  to  be  entirel}- 
formed  of  round-cells,  with  large  nuclei.  It  contained  neither  tuber- 
culous centres  nor  giant-cells ;  and  bacteriological  examination  pro- 
duced no  bacilli.  An  emulsion  formed  by  crushing  a  fragment  of  the 
tumour  in  a  little  sterilised  water  was  injected  into  the  peritoneum  of 
two  guinea-pigs.  The  day  afterwards  30  centigrammes  of  tuberculin 
were  injected  on  the  right  side  of  the  horse's  neck.  This  was  followed 
by  no  appreciable  reaction,  no  fever,  no  rise  in  pulse-rate,  etc.,  nothing 
except  a  very  trifling  swelling.  We  then  inferred  the  new  growths  to 
be  sarcomatous  in  character. 

I  may  here  add,  to  avoid  having  afterwards  to  return  to  the  ques- 
tion, that  the  result  of  inoculation  was  negative.  When  killed  at  the 
end  of  five  weeks  neither  guinea-pig  showed  an}-  tuberculous  or  sarco- 
matous lesion  whatever  on  posi-iiiortcin  examination. 

Tliere  was  no  hope  of  removing  the  tumours.  I  prescribed  2 
drachms  potassium  iodide,  and  at  a  later  stage  15  grains  of  arsenious 
acid  daily,  No  tangible  improvement  occurred.  I  now  return  to  the 
clinical  histor}-. 

Some  da}'s  after  the  horse  entered  hospital  new  tumours  appeared 
in  different  regions,  and  others  successively  followed. 

At  a  trot  the  animal's  breathing  at  once  became  laboured.  The 
horse  was  unable  to  work,  and  as  the  number  and  size  of  the  tumours 
increased  it  progressively  became  weaker. 

During  the  first  week  the  general  condition  showed  little  change  ; 


A    CASK    OF    SARCOMATOUS    DISEASE. 


109 


the  temperature  never  rose  above  38'4°  C.  (ioi-i°  F.).  The  patient 
only  ate  a  part  of  its  food,  and  was  usually  dull  and  sleepy.  The 
respiration  was  short,  and  tended  to  become  more  rapid. 

A  week  later  a  fresh  examination  gave  the  following  results  : 

General  condition  worse ;  muscular  wasting  more  marked ;  the 
bones  appeared  more  prominent  ;  the  coat  stared  :  the  lower  portions 
of  the  limb  were  swollen  ;  the  heart's  action  was  rapid  and  strong ; 
temperature  38-6°  C.  (101-4°  F.)  ;  pulse  80;  respirations  30.  Nearly 
fifty  tumours  were  counted  ;  all  the  old  ones  had  increased  in  size,  and 
a  number  of  new  tumours  were  scattered  throughout  various  regions. 
We  noted — 

On  the  left  side  of  the  body,  behind  the  shoulder  and  about  the 
middle  line  of  the  ribs,  two  new  growths  the  size  of  a  large  hen's  egg ; 
immediately  beneath  the  skin  three  smaller  flattened  tumours  ;  one 
behind  the  acromion  process ;  another  in  the  precordial  region  ;  a 
third  under  the  girth,  near  the  median  line  ;  nine  tumours  the  size  of 
a  shilling  to  that  of  a  five-shilling-piece  formed  a  string  along  the 
hypochondriac  region  ;  over  the  thin  part  of  the  fiank  were  four  similar 
tumours  ;  in  the  inguinal  region,  especially  along  the  upper  border  of 
the  internal  surface  of  the  thigh,  was  a  chain  of  tumours,  some  the  size 
of  a  pigeon's  egg;  a  large'number  of  nodules  were  scattered  through- 
out the  connective  tissue. 

On  the  right  side  were  a  few  small  tumours  around  the  large  growth 
in  front  of  the  scapula ;  along  the  hypochondriac  region  a  dozen  flat- 
tened tumours,  arranged  in  a  string  ;  in  the  thin  part  of  the  flank,  six 
inches  below  the  angle  of  the  haunch,  a  tumour  the  size  of  a  pigeon's 
egg;  in  the  groin  and  inner  surface  of  the  thigh  numerous  hard, 
isolated,  or  agglomerated  nodules  ;  immediately  below  the  inguinal 
ring  a  tumour,  difficult  to  examine,  on  account  of  its  deep-seated 
position,  but  which  appeared  large  in  size. 

On  the  inner  surface  of  the  left  forearm  a  subcutaneous  tumour  as 
large  as  a  two-shilling  piece;  nothing  on  the  right  limb;  nothing 
about  the  head  or  upper  two  thirds  of  the  neck. 

There  was  no  enlargement  of  the  sublumbar  lymphatic  glands. 
Rectal  exploration  only  revealed  the  presence  of  a  tumour  the  size  of 
a  hen's  egg  on  the  anterior  margin  of  the  left  ilium  at  the  height  of 
the  ilio-pectineal  crest. 

The  temperature  was  only  a  few  tenths  above  normal ;  the  heart's 
action  was  rapid  and  tumultuous,  the  first  sound  being  strong,  the 
second  replaced  by  a  diastolic  murmur. 

One  morning  a  few  days  after  this  examination,  when  the  patient 
seemed  in  the  same  condition  as  on  the  preceding  days,  and  had  taken 


no  CLINICAL    VETKRINAKV   MKDICINK    AND    SURC.ERV. 

a  part  of  its  food,  the  condition  suddenly  became  aggravated.  The 
horse  was  found  stretched  on  the  ground,  the  face  drawn,  the  respira- 
tion very  rapid,  dyspncea  marked,  and  the  mucous  membrane  C}anotic. 
It  rose  with  much  difficult}-,  but  almost  immediately  fell  again,  and 
struggled  violently.  The  dyspncea  became  more  and  more  marked  : 
the  animal  broke  out  in  perspiration  ;  the  limbs  became  cold  ;  and 
death  followed. 

Autopsy. — Lesions  of  asphyxia  :  mucous  membranes  cyanotic;  mus- 
cular tissues  deep  red  in  colour ;  the  capillaries  of  the  subcutaneous 
cellular  tissue  engorged  with  blackish  liquid  blood,  which  turned  red 
and  coagulated  rapidly  on  contact  with  air ;  viscera  congested  ;  patches 
of  ecchymosis  in  the  lungs,  cavities  of  the  heart,  and  under  the  endo- 
cardium. 

The  new  growth  was  more  generalised  than  had  been  suspected 
during  life.  Tumours  existed  in  very  large  numbers.  Some  were 
globular  ;  the  greater  number  flattened  ;  a  few  thinner  at  the  centre 
than  at  the  periphery.  Their  dimensions  varied  between  those  of  a  pea 
and  of  a  child's  head.  All  were  sharply  circumscribed ;  all  de\eloped 
in  the  connective  tissue — the  majority  in  the  subcutaneous  connective 
tissue, — some  under  the  serous  membranes,  and  in  the  muscular  inter- 
stices. Sections  through  muscles  failed  to  reveal  any  in  the  muscular 
trssue  itself.  The  majority  of  these  tumours,  especially  those  of  small 
size,  or  recent  formation,  had  produced  no  change  in  the  surrounding 
tissues.  Others  had  caused  inflamrhation  as  indicated  by  sclerosis,  or 
the  formation  of  a  fibrous  limiting  membrane  :  others,  again,  were  sur- 
rounded by  a  gelatinous  yellowish  or  blood-stained  exudate.  Their 
physical  characters  and  structure  varied  according  to  their  age.  The 
smaller,  or  more  recent,  were  soft  and  friable,  formed  of  a  homo- 
geneous whitish  tissue  ;  others,  of  larger  size  and  firmer  consistence, 
were  greyish  towards  the  centre ;  in  the  largest,  three  concentric 
zones  could  be  distinguished — an  external  friable  zone,  light  in  colour, 
resembling  in  structure  the  recent  tumours  ;  a  middle,  greyish  ;  finally, 
a  central,  light  yellow  in  colour  and  irregularly  defined,  formed  by 
broken-down  tissue.  The  superficial  layers  of  many  of  these  new 
growths  showed  fine  ecchymoses. 

In  the  left  hind  leg,  between  the  muscular  portion  of  the  short 
adductor,  the  pectineus  and  the  adductors  of  the  thigh,  was  a  tumour 
weighing  jf  lbs.  ;  above  the  right  shoulder,  under  the  cervical  trapezius 
and  the  rhomboideus,  another,  weighing  252  oz.  ;  behind  this  shoulder, 
between  the  great  serratus  and  great  dorsal  muscle,  still  another,  more 
than  21  oz.  in  weight. 

We  counted  fift\-  between  the  muscles  of  the  right  arm  and  the 


A    CASK    OF    SARCOMATOUS    1)ISP:ASK.  Ill 

great  serratus  muscle ;  thirty  below  the  left  shoulder.  They  were  very 
numerous  in  the  pectoral,  abdominal,  and  costal  muscles. 

On  opening  the  abdomen  we  were  struck  by  the  abundance  of  fat 
still  remaining  in  the  lumbar  region,  around  the  kidneys,  and  in  the 
pelvis.  We  only  found  one  tumour  there,  that  which  had  been  recog- 
nised by  rectal  exploration  at  the  anterior  margin  of  the  ilium.  There 
were  none  in  the  liver,  spleen,  kidneys,  or  bladder  :  nor  in  the  walls  of 
the  stomach  or  intestine.  Dissection  showed  a  few  in  the  interstices 
of  the  psosa  muscles. 

The  pleurae  contained  a  little  lemon-}ellow  liquid,  but  showed 
neither  tumours  nor  granulations.  The  left  lung  only  exhibited  the 
ordinary  lesions  of  hypostatic  congestion.  Sections  through  the 
centre  of  the  right  lung  revealed  four  recent  whitish,  friable  tumours, 
the  size  of  a  nut,  but  not  surrounded  by  any  congestive  or  inflam- 
matory zone. 

The  pericardium  contained  a  little  lemon-yellow  liquid.  Both  its 
layers  were  normal :  between  the  external  and  the  mediastinum,  dis- 
tributed in  a  layer  of  adipose  tissue,  were  about  twenty  small  flattened 
tumours. 

The  heart  showed  remarkable  lesions.  The  myocardium  appeared 
slightly  h}pertrophied,  softened,  and  pale  3ellow  in  colour.  All  the 
valves  were  deformed  b}-  the  presence  of  little  flattened  biconvex 
tumours,  developed  in  their  thickness  ;  the  largest  the  size  of  a  sixpence, 
the  smallest  of  a  pea.  In  general  they  were  closer  to  the  line  of 
insertion  than  to  the  free  margin  ;  they  were  especially  thick  in  the 
aortic  semilunar  valves.  The  diastolic  murmur  noted  during  the  last 
days  of  life  had  resulted  from  their  interfering  with  the  action  of  the 
valves.  All  were  formed  of  a  friable,  greyish-white  tissue,  punctated 
with  fine  hemorrhagic  spots. 

Finallv,  at  the  base  of  the  heart  was  a  large  lesion,  which  explained 
both  the  fatal  termination  and  its  sudden  character.  Astride  the 
bifurcation  of  the  common  aorta  and  closely  in  contact  with  both  its 
branches  was  a  large  tumour,  8  inches  in  length,  5  in  depth,  and  2|  in 
thickness,  weighing  2  lbs.  10  oz.,  surrounded  by  a  number  of  small 
satellite  new  growths,  distributed  in  a  layer  of  connective  tissue 
enveloping  the  whole.  This  tumour,  which  had  invaded  the  tunica 
adventitia  of  the  aorta,  was  intimately  adherent  to  the  middle  coat : 
the  parts  could  not  be  separated  wiith  a  director ;  it  was  necessary  to 
use  the  bistoury.  On  section,  however,  the  line  of  demarcation  was 
ver\-  clear,  the  new  greyish-white  tissue  showing  up  distinctly  against 
the  yellow  ground  of  the  arterial  wall.  Like  those  above  mentioned, 
this  tumour  could  be  divided  into  three  zones  :   a  soft   reddish  tissue. 


112  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

occupying  the  periphery,  a  denser  greyish  tissue  the  intermediate  part, 
and  yellowish  irregularly-defined  patches  the  centre.  The  two  former 
zones  were  marked  with  numerous  hsemorrhagic  points.  The  pneumo- 
gastric  nerves  were  surrounded  by  the  peripheral  layer  of  this  tumour. 

The  submaxillary  and  tracheo-bronchial  lymphatic  glands  were 
slightly  enlarged,  but  not  in  consequence  of  sarcomatous  growths. 
The  sublumbar,  inguinal,  and  prepectoral  glands  were  healthy,  despite 
the  fact  that  lymph  from  highly  infected  regions  passed  through  them. 
Nothing  whatever  in  the  nervous  centres. 

Four  days  before  death  examination  of  the  blood  had  shown  a 
proportion  of  4,562,750  red  blood-corpuscles  to  12,918  leucocytes  per 
cubic  millimetre,  i.  e.  one  white  corpuscle  to  353  red.  Generalisation 
of  the  sarcomatous  process  had,  therefore,  been  followed  by  marked 
leucocvtosis. 


There,  then,  you  have  a  very  exact  and  detailed  description  of  this 
peculiar  case. 

I  have  said  that  to  the  naked  eye  and  under  the  microscope  these 
tumours  showed  the  appearances  of  sarcomata  ;  but  of  what  variety  ? 
You  know  that  four  principal  kinds  are  distinguished  :  (i)  encephaloid 
or  globo-cellular  sarcoma,  formed  of  round-cells  with  large  nuclei  and 
scanty  protoplasm,  interspersed  with  thin-walled  embryonic  blood- 
vessels ;  (2)  fasciculated  or  fuso-cellular  sarcoma,  formed  of  elongated 
fusiform  cells  and  blood-vessels,  resembling  those  just  mentioned  ; 
(3)  myeloid  sarcoma,  a  new  growth  affecting  bony  tissue,  in  which 
large  multi-nucleated  cells  resembling  the  myeloplaxes  of  bone-marrow 
predominate  ;  (4)  and  finally,  melanotic  sarcoma,  the  tumour  of  white 
horses,  in  which  the  cells  are  full  of  grey  or  black  pigment  granules. 

The  tumours  in  our  patient  did  not  belong  to  any  of  these  varieties. 
They  were  formed  of  cells  of  unequal  size,  the  majority  rounded,  but 
some  irregular,  and  of  vessels  without  clearly-defined  walls.  In  addi- 
tion we  detected  a  reticulum,  varying  in  thickness  according  to  the 
points  examined  and  the  age  of  the  tumours. 

In  recent  tumours  all  the  cells  were  round,  while  the  reticulum  was 
delicate  and  scanty,  though  quite  clear  in  sections  which  had  been 
carefully  manipulated  with  a  brush.  In  the  larger,  older,  and  there- 
fore harder  tumours,  a  certain  number  of  the  cells  were  irregular  or 
fusiform,  and  the  reticulum  more  abundant,  forming  at  certain  points 
narrow  interlacing  bands.  Their  histological  characters  placed  these 
tumours  between  the  sarcomata  and  lymphadenomata ;  they  were 
lymphoid  or  lymphadenomatous  sarcomata. 


A    CASK    OF    SARCOMATOUS    DISKASK.  II3 

You  must  not,  however,  hastily  conclude  that  all  generalised  or 
localised  dermic  or  hypodermic  tumours,  whether  distributed  irregu- 
larly or  systematically,  are  necessarily  sarcomata.  Tuberculosis  may 
produce  similar  growths.  I  have  given  you  an  example.  Other  new 
growths  may  also  behave  in  the  same  way.  In  the  horse  and  dog 
several  cases  of  fibromatosis  have  been  reported. 

Some  years  ago  I  saw  a  bitch  affected  with  numerous  fibrous 
tumours  in  and  below  the  skin,  but  confined  exclusively  to  the  ex- 
tremities. Some  months  before  a  few  little  tumours  had  appeared  on 
the  head  and  limbs,  had  increased  in  size,  and  been  followed  by 
others.  At  the  first  glance  one's  attention  was  attracted  to  an  irregular 
flattened  tumour  the  size  of  a  five-shilling  piece  on  the  free  portion  of 
the  right  ear,  the  centre  of  which  was  excoriated  and  bleeding.  The 
left  ear,  nose,  cheek,  tail,  and  all  four  limbs  showed  other  new 
growths  in  the  skin  and  subcutaneous  tissue.  On  the  limbs  at  least 
100  could  be  counted.     None  were  seen  about  the  trunk  or  neck. 

Except  that  on  the  right  ear,  all  the  tumours  exhibited  nearly  the 
same  characters.  They  appeared  as  little  flattened,  rounded,  firm, 
slightly  prominent,  insensitive  patches.  Sections  were  hard,  white, 
and  dry,  no  liquid  exuding  even  on  pressure.  Under  the  microscope 
they  showed  the  histological  characters  of  fasciculated  fibromata. 

Palpation,  percussion,  and  auscultation  revealed  nothing  abnormal 
in  the  abdominal  and  thoracic  organs.  The  urine  was  albuminous. 
Examination  of  the  blood  showed  it  to  be  healthy. 

I  kept  this  patient  for  a  time.  At  first  it  remained  in  good  condi- 
tion, eating  well,  and  not  appearing  to  suffer  in  any  way.  Later  it 
became  dull,  lost  its  appetite,  had  attacks  of  vomiting,  suffered  from 
diarrhoea,  rapidly  lost  strength,  and  died  in  very  thin  condition.  At 
the  post-inorteui  examination  we  found  cystic  degeneration  of  both 
kidneys  ;  there  was  no  new  growth  in  the  viscera,  or  in  the  different 
tissues. 

The  tumours  were  exclusively  confined  to  the  skin  and  connective 
tissue  of  the  extremities,  head,  limbs,  and  tail. 

For  several  weeks  both  patients  received  iodine  and  arsenious 
preparations  given  alternately.  No  improvement  followed.  I  have 
often  tried  these  drugs  in  other  animals — horses  and  dogs — affected 
with  various  new  growths,  and  in  several  cases  of  lymphadenoma ;  but 
always  with  the  same  want  of  success. 


PART     II. 
MEDICAL    PATHOLOGY    AND    PRACTICE. 


.  XIX.— ACUTE    ENDOCARDITIS    IN    THE    HORSE. 

For  the  past  half-century  acute  inflammation  of  the  endocardium 
in  animals  has  been  the  subject  of  interesting  researches,  among  which 
those  of  MM.  Leblanc  and  Trasbot  merit  special  mention.  It  is  still 
generally  regarded  as  a  very  rare  affection,  partly  because  it  is  fre- 
quently overlooked,  partly  because  of  the  conditions  under  which  it 
usually  develops.* 

The  published  clinical  records  on  this  subject  refer  to  various  forms 
of  the  disease,  such  as  primary  endocarditis,  traumatic  endocarditis, 
and  endocarditis  a  frigorc,  and  secondary  endocarditis,  especially  of 
rheumatic  character.  In  the  horse,  as  in  other  animals,  primary 
endocarditis  when  occurring  must  be  of  exceptional  rarity.  I  have 
never  seen  a  case  ;  all  that  have  come  under  my  notice  were  ex- 
amples of  acute  secondary  endocarditis,  the  majority  in  animals 
suffering  with  or  convalescent  from  pneumonia.  I  will  describe  two 
cases. 

Last  winter  I  had  an  opportunity  of  examining  a  case  of  pneumonia, 
in  which  the  pulmonary  disease  was  complicated  with  endocarditis. 
The  history  of  the  case  is  shortly  as  follows  : 

One  morning  towards  the  end  of  January  the  animal  left  a  portion 
of  its  first  feed,  and,  although  it  was  put  to  work,  the  coachman 
noticed  that  it  was  dull,   appeared  tired,  and  stopped  from   time  to 

*  In  1863,  at  the  Central  Society  of  Veterinary  Medicine,  Colin  still  disputed  the 
occurrence  of  endocarditis  and  myocarditis  in  the  horse.  He  declared  he  had  never  seen 
false  membranes  on  the  endocardium,  nor  valvular  insufficiency.  He  referred  the  white 
patches  formed  by  cicatricial  tissue,  which  he  had  often  seen  in  the  horse,  to  partial  ruptures 
of  the  muscular  fibres. 


Il6  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY- 

time  ;  expiration  was  accompanied  by  a  moaning  sound.  On  returning 
to  the  stable  it  only  took  a  little  food  and  refused  its  corn.  Next  day 
these  symptoms  were  supplemented  by  cough,  and  slight  discharge 
from  both  nostrils.  A  veterinary  surgeon  who  was  called  in  diagnosed 
the  case  as  one  of  commencing  pneumonia,  bled  the  animal  to  the 
extent  of  8^  pints,  and  prescribed  tartar  emetic  and  iodide  of  potassium. 
Up  to  the  seventh  day,  although  both  lungs  were  attacked,  no  alarming 
symptoms  appeared.  Between  the  morning  and  evening  of  the 
eighth,  however,  the  patient's  condition  became  greatly  aggravated. 
I  examined  it  on  the  following  afternoon.  Both  lungs  gave  signs 
of  hepatisation  ;  and  on  auscultating  the  heart  (the  action  of  which 
was  rapid  and  feeble)  I  noted  a  slight  soft  murmur  during  the  second 
sound  and  the  pause,  a  murmur  indicating  aortic  insufficiency.  The 
history  of  the  animal  left  very  little  doubt  as  to  the  significance  of  this 
symptom.  Nevertheless,  with  due  reserve — because  this  murmur 
might  have  been  due  to  a  valvular  lesion  anterior  to  the  pneumonia  ; 
a  not  uncommon  condition  in  hard-worked  horses — with  due  reserve, 
I  say,  I  declared  that  the  endocardium  was  inflamed,  and  that  the 
sudden  aggravation  in  the  animal's  condition  was  caused  in  part  at 
least  by  this  complication.     Some  days  later  the  animal  died. 

At  the  post-mortem  examination  we  found,  in  addition  to  numerous 
centres  of  pulmonary  gangrene,  lesions  of  acute  endocarditis,  which  I 
now  submit  to  you. 

On  the  upper  surface  of  the  mitral  valves  and  lower  surface  of  the 
aortic  semilunar  valves,  principally  towards  their  free  margins,  you 
will  see  little  greyish  vegetations  ;  some  fairly  firm,  others  soft  and 
friable.  You  will  also  note  that  these  valves  are  slightly  injected  and 
infiltrated,  and  that  they  show  no  old-standing  lesion. 

Five  years  ago  I  saw  a  similar  case,  so  far  as  concerns  the  atiology 
and  localisation  of-  the  endocardial  lesions.  In  this  case  also  endocar- 
ditis of  the  aortic  valves  had  occurred  during  the  course  of  pneumonia. 
The  animal  recovered,  and  although  final  proof  that  the  aortic  valves 
were  attacked  could  not  be  furnished,  as  in  the  first  case,  it  was  clearly 
established  by  the  subsequent  symptoms.  The  pneumonia  ended  in 
resolution  ;  but  the  endocarditis  produced  chronic  lesions.  After  a  short 
convalescence  this  horse  returned  to  work.  A  year  later  I  again 
examined  him,  when  he  was  suffering  from  aortic  insufficiency,  clearly 
shown  by  a  strong  diastolic  murmur.  This  valvular  lesion  neither 
disappeared  nor  diminished  ;  on  the  contrary,  it  ended  by  producing 
complications,  of  which  I  shall  speak  in  a  subsequent  lecture. 

A  fairly  large  number  of  cases  of  acute  secondary  mitral  endocar- 
ditis have  been  published.     You  might  read  with  profit  those  published 


ACUTE    ENDOCARDITIS    IN    THE    HORSE.  II7 

by   M.  Trasbot    in   the  Archives    VHcrinaircs  for  the  years   1878  and 


Although  the  causation  and  pathology  of  acute  endocarditis  are 
complex,  you  may  regard  it  as  certain  that  the  affection  is  always 
secondary,  and  produced  by  toxic  infection  ;  and  furthermore,  that 
it  is  much  more  frequently  due  to  pulmonary  inflammation  than 
has  hitherto  been  admitted.  The  endocardium  is  known  to  be  par- 
ticularly sensitive  to  the  action  of  infectious  processes,  and  to  be  easil}' 
injured  by  microbes  and  their  toxins.  In  pneumonia,  and  especially 
in  the  contagious  form,  the  lung  is  the  seat  of  active  microbic  growth. 
Infectious  agents  passing  into  the  still  pervious  pulmonary  vessels 
have  but  a  short  distance  to  traverse  before  reaching  the  heart,  and  we 
well  know  that  they  are  capable  of  producing  disturbance  in  viscera 
much  more  distant  from  the  lung.  Suspended  in  the  blood  they  neces- 
sarily pass  through  the  left  heart ;  they  may  adhere  to  the  endocardium, 
appearing  in  such  case  specially  to  affect  the  irregularities,  prominences, 
and  folds  in  the  serous  coat,  especially  in  that  covering  the  valves, 
which,  as  we  know,  are  the  most  common  seat  of  the  lesions  of  acute 
endocarditis.  This  localisation  of  the  process  on  the  valves  is  evidently 
due  to  incessantly  repeated  "  quasi  injuries,"  resulting  from  the 
heart's  own  action,  the  free  edges  of  the  auriculo-ventricular  valves 
during  systole,  and  of  the  semilunar  valves  during  diastole  being 
violently  hurled  backwards  and  forwards.  This  explains  their  vulner- 
ability at  these  points,  and  the  readiness  with  which  the}-  become 
inoculated  when  bathed  in  infected  blood. 

In  addition  to  surgical  infections,  strangles,  influenza,  pneumo- 
enteritis  resulting  from  bad  fodder,  glanders,  and,  in  fact,  all  morbid 
conditions  due  to  the  presence  of  microbes  in  the  lungs,  may  be 
accompanied  by  endocarditis.  The  blood  may  become  infected 
through  trifling  lesions  of  the  skin  or  mucous  membrane — in  fact 
the  points  of  entry  for  pathogenic  organisms  are  innumerable,  and 
though  sometimes  easy  to  identify,  are  oftener  undiscoverable. 

At  the  autopsy  of  an  old  horse,  M.  Blanc  found  ulcerative  endo- 
carditis consecutive  to  inflammation  of  the  biliary  ducts.  A  less 
careful  observer  would  have  recorded  this  as  primary  in  origin,  or  due 
to  chill. 

It  should  be  remarked  that  the  lesions  are  usually  localised  in  the 
left  heart,  even  wlien  the  infections  agents  enter  the  veins  of  the  systemic 
circulation,  and  therefore  first  reach  the  right  heart.  This  commoner 
affection  of  the  left  heart  has  been  explained  in  various  ways.  Some 
consider  it  due  to  the  more  active  function  of  this  part  of  the  organ, 


Il8  CLINICAL    VETERINARY    i\IEDICINE    AND    SURGERY. 

and  the  more  intense  strain  and  rubbing  to  which  the  serous  mem- 
brane is  subject.  Others  declare  that,  as  endocarditis  is  usually 
caused  by  aerobic  microbes,  the  superior  richness  in  oxygen  of  the  left 
heart  blood  constitutes  a  predisposing  factor.  In  the  horse  the  pre- 
dominance of  left  endocarditis  is  probably  a  result  of  the  frequence  of 
pulmonary  inflammation,  during  which  the  endocardium  of  the  left 
side  is  particularly  exposed  to  infection. 

Acute  endocarditis  may  be  produced  by  different  microbes.  In 
man,  where  the  subject  has  been  much  better  studied  than  in  animals, 
the  lesions  most  commonly  contain  micrococci,  staphylo-  and  strepto- 
cocci, pneumococci,  gonococci,  and  less  commonly  Eberth's  bacillus, 
the  Bacillits  colt  communis,  and  the  Bacillus  tuberculosis.  MM.  Gilbert 
and  Lyon  have  noted  a  paracoli  bacillus.  Weichselbaum  discovered  a 
microbe  never  before  seen  in  other  diseases.  The  same  species  of 
microbes  have  been  found  in  the  principal  anatomical  forms  of  endo- 
carditis— the  vegetating  and  the  ulcerating.  The  characters  of  the 
lesions  seem,  then,  to  depend  especially  on  the  degree  of  virulence 
of  the  infectious  agents.  In  addition  to  these,  one  sees  so-called 
cryptogenic  endocarditis,  from  which  pathological  agents  have  not 
yet  been  isolated.  In  endocarditis  lesions  in  the  horse  Penberthy  and 
Fuchs  found  micrococci.  In  a  case  of  tuberculosis  I  detected  the 
specific  bacillus. 

Inflammation  of  the  endocardium  frequently  complicates  rheu- 
matism, and  is  due  to  the  same  cause  as  the  arthritis,  synovitis, 
pleurisy,  and  pericarditis.  Apart,  however,  from  the  pseudo-rheu- 
matism which  follows  pneumonia,  acute  rheumatism  is  rare  in  the 
horse,  and  endocarditis  arising  from  this  cause  is  much  less  common 
than  the  forms  of  which  I  have  just  spoken. 

At  the  present  day  we  are  all  agreed  as  to  the  extreme  rarity  of 
acute  primary  endocarditis — what  has  been  called  endocarditis  a 
frigore.  Cold  alone  can  no  more  produce  it  than  can  an  aseptic 
injury  ;  its  action  must  be  preceded,  or  accompanied,  by  some  other 
pathological  influence  which  plays  the  principal  part,  that  is  to  say, 
the  entrance  of  some  microbe.  Cold  here  acts  as  in  pneumonia  a 
frigore,  by  diminishing  the  resistance  of  the  organism,  thus  favouring 
infection,  the  latent  centres  of  which  are  numerous.  Infection  may 
occur  through  the  uninjured  membrane  of  the  respiratory  tract  ;  ex- 
periments seem  to  have  established  that  various  microbes  can  traverse 
the  pulmonary  epithelium  without  any  preliminary  lesion,  and  pass 
into  the  circulation  by  way  of  the  lymphatic  channels. 

It  has  been  suggested  that  certain  therapeutic  or  toxic  materials, 
internally  administered,  are  capable  of  producing  acute  inflammation 


ACUTE    ENDOCARDITIS    IN    THE    HORSE.  HO 

of  the  endocardium.  Digitalis  was  said  to  have  this  effect,  especially 
when  given  in  large  doses,  intermittently,  and  for  a  long  time.  It  is 
quite  certain  that  such  substances  can  do  no  more  than  favour 
infection. 

Traumatic  endocarditis,  resulting  from  cardiac  lesions  produced  by 
infected  foreign  bodies,  is  chiefly  a  laboratory  disease.  Endocarditis 
and  myocarditis  sometimes  co-exist,  and  it  has  been  sought  to  explahi 
the  former  on  the  basis  of  extension  to  the  serous  membrane  of 
inflammation  of  the  heart  muscle ;  but,  in  most  cases  of  this  kind,  the 
muscular  and  serous  tissues  are  simultaneously  attacked. 

Depending  on  its  nature,  and  the  species  or  virulence  of  the 
microbic  agents  which  produce  it,  endocarditis  may  remain  localised, 
soon  lose  its  infectious  character,  become  chronic,  and  only  produce  a 
few  innocent  fibrous  lesions,  being  then  described  as  benign  (the  form 
most  commonly  seen  in  the  horse)  ;  or  it  may  preserve  its  original 
infective,  spreading  character,  when  it  is  known  as  malignant  endo- 
carditis. 

I  need  only  rapidly  recite  the  generally  accepted  symptomatology 
in  order  to  convince  you  that  this  disease  has  been  credited  with  effects 
for  which  it  is  in  no  way  answerable,  but  which  result  from  a  general 
infection,  of  which  the  endocarditis  is  only  an  accompaniment.  Pro- 
found depression,  absolute  loss  of  appetite,  high  fever,  warmth  of  the 
skin,  acceleration  of  the  chief  functions,  dyspnoea,  violent  cardiac 
action,  "purring  tremor"  (fremissement  cataire),  metallic  heart 
sounds,  sometimes  irregularity  of  the  heart,  intermittencies,  venous 
pulse,  a  murmur  during  the  first  or  second  sound  ;  at  a  later  stage, 
paresis  or  paralysis,  albuminuria,  and  icterus  (produced  by  visceral 
emboli)  ;  finally,  loss  of  strength  and  collapse  ;  such  are  said  to  be  the 
principal  symptoms  produced  by  acute  endocarditis,  under  the  varying 
forms  which  it  may  assume. 

In  point  of  fact  the  condition  generally  passes  unperceived,  masked 
by  the  symptoms  of  the  accompanying  disease.  When  it  occurs  as  a 
primary  affection  the  general  symptoms  scarcely  diifer  from  those 
accompanying  many  other  diseases  of  the  viscera.  The  only  special 
symptoms  are  those  recognised  on  auscultation,  and  the  sole  symptom 
by  which  it  is  identified  is  the  murmur. 

This  is  sometimes  systolic,  originating  in  the  auriculo-ventricular 
orifice — a  feeble,  soft  sound,  deep  in  some  patients,  strong  and 
vibrating  in  others.  In  the  latter  case,  which  is  exceptional,  the 
"purring  or  vibratory  tremor  "  may  be  detected  by  applying  the  hand 
over  the  pra:;cordial  region  ;  but  the  symptom,  though  mentioned 
by  all  authors,  is  distinctly    uncommon.     Sometimes  the  murmur  is 


I20  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

diastolic,  produced  b}-  aortic  insufficiency.  Finally,  at  times  one 
first  hears  a  systolic,  followed  by  a  diastolic  murmur  ;  the  diastolic 
sound  always  appears  at  a  later  stage  than  the  systolic,  the  lesions 
of  the  semilunar  valves  being  of  slower  development,  or  progressing 
less  rapidly  than  those  of  the  mitral.  In  certain  patients  the  heart- 
beats occur  at  regular  intervals,  only  seeming  rather  stronger  than 
usual,  and  the  pulse  is  normal  or  somewhat  weak.  In  others  the 
action  of  the  heart  is  more  or  less  irregular  ;  intermittencies  are  rare, 
and  always  of  brief  duration.  In  the  simple  forms  of  acute  endocar- 
ditis, true  palpitation  and  dyspnoea  are  not  seen  at  rest  ;  the  heart 
muscle  being  only  affected  to  a  very  trifling  extent,  the  lesions  do  not 
produce  an)'  noteworthy  external  symptoms.  Nevertheless,  mitral 
insufficiency  may  occur  in  consequence  of  weakness,  or  of  paresis  of 
the  musculi  papillares. 

When  endocardium  and  myocardium  are  simultaneously  affected, 
or  when  endo-pericarditis  exists,  the  symptoms  are  more  complicated. 
The  descriptions  just  referred  to  seem  most  suggestive  of  infective 
endomyocarditis,  or  of  endocarditis  preceded,  or  complicated,  by  grave 
pulmonary  mischief. 

When  in  vegetative  endocarditis  the  inflammatory  growths  on  the 
valves  are  of  large  size,  the  same  train  of  symptoms  occurs,  but  in  a 
more  marked  form.  To  symptoms  indicative  of  mitral  and  aortic 
insufficiency  are  added  others  suggesting  stenosis  of  these  orifices. 
And  as,  furthermore,  the  risks  of  embolism  are  greater  than  in  simple 
endocarditis,  symptoms  pointing  to  obliteration  of  vessels  in  internal 
organs  are  more  frequent.  Cerebral  embolism — rare  in  all  animals — 
is  rapidly  followed  b}-  death,  or  by  more  or  less  extensive  paralysis ; 
renal  embolism  produces  albuminuria  and  haematuria ;  intestinal 
embolism  colic ;  that  of  an  important  artery  in  a  limb,  lameness,  and 
sometimes,  more  or  less  extensive  gangrene  ;  that  of  the  spleen,  and  of 
some  other  organs  and  tissues,  gives  rise  to  no  visible  symptoms. 

Malignant  ulcerative,  or  septic  endocarditis  is  recognised,  not  only 
by  the  general  signs  drawn  from  auscultation,  but  by  symptoms  usually 
of  an  extremely  grave  character,  similar  to  those  of  a  rapidly  progressive 
infection  or  intoxication,  which  point  to  general  poisoning  of  the 
system  by  pathogenic  org'anisms,  or  their  toxins.  Fever  is  intense; 
there  is  great  prostration,  rigors,  sweating,  diarrhoea,  albuminuria, 
haematuria,  colic,  frequent  groaning,  cyanosis  of  the  mucous  mem- 
branes, rapid  acceleratir^  ~)f  the  heart's  action,  loss  of  pulse,  and 
sometimes  local  ha;mor mages.  The  symptoms  soon  become  more 
marked,  and  collapse  is  followed  by  death.  This  endocarditis  may  be 
due  to  the  presence  of  one  or  more  species  of  organisms,  but  is  always 


ACUTK    KNDOCARDITIS    IN    THK    HOKSK.  121 

exceedingh'  infective,  and  its  real  nature  is  often  misinterpreted,  until! 
after  death. 

In  animals,  the  changes  shown  by  the  endocardium  after  acute 
inflammation  are  very  diversified.  On  reading  reported  cases  of  "  acute 
endocarditis  "  in  journals,  it  is  clear  that  in  many  instances  the  changes, 
noted  do  not  justify  the  signification  attributed  to  them.  Cases  have 
been  published  under  this  title  in  which  the  existence  of  endocarditis, 
was  in  no  way  demonstrated,  even  by  the  lesions. 

The  diffuse  reddening  of  the  serous  membrane,  the  ecchymoses,. 
the  irregular  blackish  patches,  even  the  little  fibrinous  grains  which 
have  been  found,  are  by  no  means  sufficient  indications  on  which  to- 
base  the  diagnosis  of  acute  endocarditis.  Diffuse  reddening  of  the  endo- 
cardium results  from  staining  with  altered  haemoglobin,  derived  from  red 
blood-corpuscles  destroyed  during  the  course  of  certain  infectious  pro- 
cesses. The  other  lesions  are  not  infrequently  seen  in  horses  which  die 
from  over-exertion,  especially  in  extremely  hot  weather.  They  also  occur 
when  death  is  preceded  by  violent  struggling  and  long-continued  agony. 

In  the  ordinary  form  of  acute  endocarditis  the  serous  membrane  is 
thickened  or  elevated  in  places,  has  lost  its  polished  appearance,  is 
covered  with  little,  friable,  greyish  or  reddish  vegetations,  at  times 
capped  with  a  fibrinous  layer,  and  marked  at  the  seat  of  these  lesions 
and  for  some  distance  round  them  by  fine  branching  vessels.  There  is 
nothing  more.  These  lesions  sometimes  extend  over  a  considerable 
portion  of  the  endocardium  ;  they  commonly  affect  the  valves,  and  are 
there  always  most  marked.  They  are  generally  confined  to  the  left 
heart.  The  mitral  and  aortic  valves  are  swollen,  irregularly  thickened, 
often  covered  with  little  sessile  vegetations  adherent  to  and  continuous, 
with  the  membrane,  some  greyish  in  colour,  others  of  a  light  red  ;. 
sometimes  very  small,  very  numerous  and  almost  confluent ;  they  give 
the  membrane  a  roughened  appearance.  In  the  specimen  I  exhibit,, 
you  see  they  are  collected  at  a  short  distance  from  the  free  border  of 
the  valve.  In  many  cases  they  first  appear  in  the  vascular  portion 
of  the  valves,  and  extend  thence  towards  the  free  margin  ;  where 
they  attain  the  free  edge  of  the  valves  the  endocarditis  is  termed 
marginal.  The  abnormal  coloration  is  not  removed  by  washing,  and 
closer  examination  of  the  patches,  especially  of  their  circumference, 
reveals  little  vascular  loops ;  but  the  reddish-brown  or  blackish  tints 
which  appear  so  rapidly  in  inflammation  of  richly  vascular  organs  are 
rarely  seen.  The  majority  of  these  vegetations  are  covered  with  a 
fibrinous  deposit  seldom  very  adherent.  On  removing  it  the  serous, 
membrane  appears  superficially  eroded. 


122  CLINICAL    VETKRINARY    MEDICINE    AND    SURGERY. 

At  one  time  new  growths  on  the  endocardium  were  always  regarded 
as  fibrinous.  They  are  really  formed  of  embryonic  cells  and  leucocytes, 
held  together  by  a  small  quantity  of  structureless  exudate.  Beneath 
and  around  them  the  endocardium  appears  infiltrated  with  similar 
cells,  the  number  of  which  diminishes  in  proportion  to  the  distance 
from  the  vegetation.  The  persistence  of  the  endothelium  over  the 
surface  of  certain  deposits  indicates  that  the  process  develops  partly 
in  the  deep  layer  of  the  serous  membrane  ;  as  a  rule,  however,  the 
superficial  layer  is  first  loosened,  and  afterwards  destroyed.  There  is 
little  or  no  discharge  from  the  point  ;  acute  endocarditis  is  pro- 
liferative, not  exudative.  When  the  chordae  tendineae  are  invaded,  or 
that  portion  of  the  endocardium  into  which  they  are  inserted  is 
affected,  they  may  snap  or  become  detached  from  their  insertion — 
an  accident  sometimes  followed  by  mitral  insufficiency.  When  the 
inflammation  extends  from  the  deep  layer  of  the  endocardium  to  the 
heart  muscle  itself,  it  always  remains  limited  to  a  very  thin  stratum. 
It  is  possible,  however,  as  I  before  stated,  for  both  the  muscle  and 
serous  membrane  to  be  simultaneously  affected,  and  during  infectious 
diseases  this  occurs  more  frequently  than  might  be  imagined  from  the 
few  cases  published. 

Vegetative,  or  verrucous,  endocarditis  is  characterised  by  the 
abundance  and  size  of  the  granulations  developed  on  the  endo- 
cardium. The  proliferation  of  cells  and  exudation  of  leucocytes 
rapidly  produce  luxuriant  vegetations,  varying  greatly  in  size  and 
shape.  In  this  case,  also,  the  valves  show  the  maximum  of  develop- 
ment. Sometimes  the  growths  resemble  branching  stalactites,  covered 
with  conical  prolongations,  the  long  axes  of  which  correspond  in 
direction  with  that  of  the  blood-stream  ;  those  fixed  to  the  mitral 
valve  pointing  towards  the  base  of  the  ventricle ;  those  on  the  semi- 
lunar valves  towards  the  aorta.  These  large  new  growths  are  com- 
posed of  cells,  etc.,  similar  in  nature  to  those  forming  the  limited 
vegetations  of  simple  endocarditis.  They  usually  show  a  superficial 
fibrinous,  and  a  deep  organised  layer,  the  latter  continuous  with  the 
endocardium  ;  some,  however,  are  organised  nearly  throughout ;  others 
are  almost  exclusively  fibrinous.  Such  large  new  growths  are  rare  in 
the  horse,  but  are  commoner  in  the  dog.  Not  only  do  they  diminish 
the  size  of  the  orifices  around  which  they  are  situated,  and  thus 
produce  functional  disturbance,  but  they  threaten  embolism  of  in- 
ternal organs.  Incessantly  agitated  by  the  blood-stream,  the  fibrinous 
•coagula  covering  these  vegetations  may  become  detached  and  carried 
to  a  distance,  produce  infarcts  in  the  viscera  and  in  various  tissues,  thus 
.giving  rise  to  symptoms  of  very  varying  gravity.     Under  the  influence 


ACUTK    KNI^OCARDITIS    IN    THK    HORSE.  I23 

of  active  microbic  growth,  or  of  degenerative  changes,  the  vegetations 
may  break  down  suddenly,  throwing  into  the  blood-stream  large 
numbers  of  fragments,  which  produce  multiple,  simple,  or  specific 
embolisms,  and  in  some  cases  rapidly  progressive  septicaemia. 

In  ulcerative  endocarditis  (which  is  still  rarer  than  the  preceding) 
the  serous  membrane  shows  loss  of  substance ;  true  ulcers  may 
develop  on  the  walls  of  the  ventricles,  or  on  the  valves ;  most  fre- 
quently on  the  mitral.  Starting  in  the  endocardium,  and  at  first 
limited  in  extent,  these  ulcers  extend  more  or  less  rapidly  in  size  and 
depth,  and  may  perforate  and  partially  destroy  the  valves.  When 
affecting  the  parietal  endocardium  they  sometimes  extend  beyond  its 
deep  layer,  erode  the  myocardium,  and  produce  a  kind  of  aneurism. 

Visceral  complications  due  to  emboli  are  frequent.  The  blood  is 
charged  with  micro-organisms,  masses  of  cells,  and  broken-down 
material  from  the  ulceration,  and  is  greatly  changed  in  character. 
Pyaemic  or  septicaemic  lesions  are  not  infrequent. 

In  acute  endocarditis  affecting  the  valves  diagnosis  becomes  possible 
as  soon  as  a  murmur  develops.  When,  however,  localised  in  the 
parietal  endocardium  or  affecting  the  valves,  but  without  causing 
insufficiency,  detection  is  impossible.  It  is  perhaps  well  to  repeat 
that  even  when  alarming  general  symptoms  occur,  suggesting  acute 
endocarditis,  the  existence  of  a  murmur  is  of  doubtful  significance,  and 
may  be  due  to  old-standing  heart  disease,  the  accompanying  disturb- 
ance resulting  from  some  other  affection,  such  as  pneumonia.  In  most 
cases  minute  examination  of  the  patient  is  necessary  before  giving  an 
opinion,  and  sometimes  a  few  days  must  be  allowed  to  elapse  for  the 
condition  to  develop. 

The  prognosis  of  acute  endocarditis  is  very  grave  ;  although  in  the 
horse  it  may  not  prove  fatal,  it  produces  lesions  which  are  not  only 
incurable,  but  which  become  more  marked  with  lapse  of  time,  and 
often  make  rapid  progress  when  animals  are  put  to  heavy  work  soon 
after  leaving  hospital. 

Treatment  is  of  little  value.  Bleeding,  counter- irritation,  and  the 
internal  administration  of  digitalis,  salicylate  of  soda,  iodide  of  potas- 
sium, alcohol,  and  diuretics  have  been  recommended. 

When  endocarditis  appears  during  the  course  of  another  disease,  a 
general  infection  or  a  microbic  disease  of  any  kind,  it  forms  a  menacing 
complication  ;  but  treatment  should  still  be  principally  directed  against 
the  primary  morbid  condition,  and  not  against  the  complication. 

The  belief  that  acute  endocarditis  can  be  cut  short  by  any  system 


124  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

of  medication  is  a  pure  illusion.  Even  rheumatic  endocarditis,  against 
which  v^'e  have  drugs  of  a  specific  character,  always  passes  through  its 
various  phases,  and  leaves  permanent  lesions  in  the  endocardium.  In 
a  certain  number  of  cases  we  can  diminish  the  intensity  of  the  inflam- 
matory process  in  the  endocardium,  moderate  development  of  new 
growths,  and  consequentl}'  reduce  the  dangers  of  embolism  and  of 
visceral  thrombosis  ;  but  that  is  the  full  extent  of  our  powers.  Even 
then  success  is  distinctl}'  problematical. 

In  primary  and  secondary  endocarditis  it  is  usual  first  to  bleed  and 
apply  counter-irritants.  Six  to  ten  pints  of  blood  are  withdrawn,  and 
a  large  mustard  plaster  applied  to  the  lower  half  of  the  chest  ;  or  the 
left  surface  of  the  chest  over  the  heart  is  blistered.  Some  authors 
claim  to  have  had  good  results  from  continued  irrigation  of,  or  appli- 
cation of  ice  to,  the  prsecordial  region. 

Internally  the  most  useful  agents  are  sulphate  of  quinine,  given  in 
electuary  in  doses  of  2 i  to  5  drachms  per  day ;  and  in  the  rheumatic 
form,  salicylate  of  soda  in  doses  of  5  to  10  drachms. 

Digitalis,  empirically  prescribed  in  all  cardiac  diseases,  is  here  of 
real  use  if  the  rhythm  of  the  heart  is  irregular,  or  if  myocarditis  has 
accompanied  or  followed  inflammation  of  the  endocardium  ;  it  regulates 
the  action  of  the  heart  muscle.  At  the  end  of  some  days  moderate 
doses  of  potassium  iodide  have  a  good  effect,  appearing  to  favour 
absorption  of  exudates.  If  fever  is  high  antipyrin  and  cold  enemata 
may  be  given  ;  when  weakness  is  marked,  stimulants  and  antiseptics 
seem  indicated. 

In  his  Lecons  siir  les  Antiseptiqucs  M.  Bouchard  draws  attention  to 
the  good  effects  produced  by  internal  administration  of  antiseptics  in 
many  microbic  diseases.  In  infectious  forms  of  endocarditis  the  ideal 
method  of  treatment  would  consist  in  destroying  the  organisms  in  or 
on  the  endocardium.  At  present  this  is  impossible,  but  by  using 
antiseptics  we  can  arrest  or  diminish  man}-  primary  infectious  processes, 
of  which  endocarditis  only  forms  a  complication. 


XX.— AORTIC   INSUFFICIENCY    IN    THE    HORSE. 

To-day  we  saw  in  the  clinique  a  horse  with  very  well-marked 
aortic  insufficiency,  and  I  mentioned  to  you  in  some  detail  the  pecu- 
liarities shown  by  the  animal.  I  have  had  opportunities  of  seeing  a 
very  considerable  number  of  similar  cases.  To-day  I  intend  to  treat 
of  this  condition,  and  while  describing  certain  cases,  to  point  out  the 
diagnostic  symptoms. 

In  the  horse  aortic  insufficiency  is  by  far  the  most  frequent  of  all 
heart  diseases.  It  may  be  seen  in  animals  of  all  ages,  without  distinc- 
tion of  sex  or  breed,  though  the  majority  of  published  cases  refer  to 
old  animals  slaughtered  for  experimental  or  anatomical  purposes.  In 
animals  of  this  class  M.  Nocard  and  I  found  thirty-eight  aortic  and 
four  associated  aortic  and  mitral  lesions  in  a  total  of  forty-two  cases. 

Aortic  insufficiency  sometimes  forms  an  isolated  lesion,  sometimes 
an  accompaniment  of  other  lesions  of  the  endocardium,  or  of  arterial 
atheroma.  In  man,  where  the  latter  condition  is  very  common,  aortic 
insufficiency  of  cardiac  origin,  consecutive  to  endocarditis,  is  distin- 
guished from  insufficiency  of  arterial  origin  associated  with  sclerosis 
of  the  arteries.  In  the  horse  valvular  lesions  are  sometimes  accom- 
panied by  atheroma  of  the  aorta,  but  very  generally  atheroma  is  absent, 
and  the  valvular  disease  simple,  or  only  combined  with  other  valvular 
changes. 

With  very  rare  exceptions,  it  results  from  some  infectious  process, 
during  which  the  endocardium  has  been  injured  by  blood-borne  micro- 
organisms, or  their  toxins.  It  may  also  follow  acute  inflammation  of 
the  lung,  especially  the  contagious  form,  and  the  typhoid  form  of 
influenza.  Rheumatism,  which,  as  you  know,  is  rare  in  the  horse,  also 
appears  to  produce  it.  In  human  medicine  it  has  long  been  known 
that  rheumatic  lesions  appear  to  have  a  decided  predilection  for  the 
endocardium,  etc.,  which  they  permanently  affect.  "  Rheumatism," 
said  a  celebrated  clinician,  "licks  the  joints,  the  pleura,  and  even  the 
meninges,  but  it  gnaws  the  heart." 

Whatever  the  determining  cause,  inflammation  of  the  semilunar 
valves  soon  assumes  a  chronic  character,  and   determines  a  series  of 


126 


CLINICAL    VETERINARY    MEDICINE    AND    SURCIERV. 


changes  ending  in  insufficiency.  These  changes  may  assume  very 
varying  anatomical  appearances.  You  may  judge  of  this  by  examining 
the  specimens  I  place  before  you.  Sometimes  the  valves  are  simply 
thickened,  rigid,  wrinkled,  and  shrivelled  ;  sometimes  they  show  losses 
of  substance,  giving  them  a  reticulated  or  fenestrated  appearance  ;  in 
some  cases  they  exhibit  aneurismal  dilatations,  projecting  above  the 
surface  of  the  heart,  the  wall  of  the  aneurism  being  either  intact  or 
perforated  ;  in  others,  again,  they  are  fungous  and  covered  with  pea- 
like or  strawberry-like  vegetations  ;  finally,  they  may  contract  adhe- 
sions one  with  the  other,  or  with  adjacent  tissues.  Usually  these 
lesions  are  unequally  marked  on  the  three  valves  ;   sometimes  they 


Fig.  1 6. — Chronic  endocarditis  of  the  aortic  valves. 


only  affect  one,  though  even  in  this  case  they  may  be  very  pro- 
nounced. 

The  valves  never  close  completely,  an  opening  of  varying  form 
and  size  remaining  between  them  through  which  blood  regurgitates. 
When  the  aortic  ring  has  not  been  divided  the  insufficiency  can 
readily  be  detected.  After  removing  its  lower  third,  one  has  only  to 
place  the  heart  in  a  vertical  position,  and  to  pour  a  little  water  into  the 
aorta  ;  the  valves  no  longer  closing  exactly,  liquid  escapes  by  the  space 
between  the  valves,  and  passes  into  the  ventricle. 

These  changes  in  the  aortic  opening  are  always  accompanied  by  a 
certain  degree  of  hypertrophy  of  the  left  ventricle,  consequent  on 
insufficiency,  and  due  to  a  very  simple  mechanism.  After  each  systole, 
the  blood  injected  into  the  aorta,  which  should  be  retained  by  closure 
of  the  semilunar  valves,  returns  in  part  into  the  ventricle.  This 
returned  blood  being  added  to  that  coming  from  the  auricle,  two 
abnormal  conditions  successivel}'  arise ;  the  ventricle  dilates  excessively, 


AORTIC    INSUFFICIENCY    IN    THE    HORSE.  I27- 

and  then  contracts  with  a  degree  of  energy  greater  in  proportion  to  the 
quantity  of  blood  which  it  contains,  and  to  the  diminution  in  the 
arterial  pressure  in  the  common  aorta.  Now  this  more  active  contrac- 
tion of  the  left  ventricle  is  repeated  about  50,000  times  per  twenty-four 
hours.  The  increase  in  work  ends  by  causing  hypertrophy  of  the 
cardiac  muscle,  which,  for  a  certain  time  at  least,  renders  the  heart 
capable  of  overcoming  the  increased  demand  imposed  on  it  b}-  the 
condition  of  the  valves,  but  which  culminates  in  the  period  of  asystole  ;. 
the  heart  muscle,  enfeebled  by  over- exertion,  undergoes  degenerative 
changes,  finally  leading  to  death.  The  heart  may  attain  very  great 
dimensions.  Whilst  the  medium  weight  for  a  healthy  heart  is  about 
Y^  that  of  the  whole  body,  a  heart  with  aortic  lesions  and  insufficiency 
often  attains  j-^^  to  -^^^  of  this  weight.  Sclerotic  changes  of  the 
muscular  substance  are  rare,  because  most  patients  are  slaughtered 
before  they  can  develop.  Nevertheless  I  have  seen  a  certain  number 
of  cases  in  the  school,  one  of  which  I  will  describe  in  a  later 
lecture. 

Aortic  insufftciency  is  indicated  by  two  principal  s}'mptoms  :  (i)  a 
diastolic  murmur,  loudest  at  the  base  of  the  heart  ;  (2)  a  strong  pulse, 
readily  perceptible  in  all  accessible  arteries. 

The  murmur  commences  with  diastole,  and  continues  during  the 
second  sound,  and  a  portion,  or  the  whole,  of  the  pause  ;  it  immediatel}' 
follows  the  short  pause,  at  the  moment  when  the  semilunar  valves  have 
returned  to  their  horizontal  position,  and  continues  until  the  first  period 
of  the  following  cardiac  cycle,  /.  e.  until  the  precordial  impulse  produced 
by  ventricular  systole.  I  said  that  it  was  loudest  at  the  base  of  the 
heart  ;  it  may  also  be  heard,  though  less  distinctly,  as  low  as  the 
apex,  and  more  rarely  in  the  region  above  the  heart  over  the  aortic 
trunk.  The  tone  (timbre)  of  this  murmur  varies ;  usually  it  is  soft 
and  hissing ;  sometimes  it  is  rough,  grating,  or  musical.  I  may  add 
that  no  close  connection  can  be  established  between  these  variations  in 
sound  and  the  age,  degree,  or  peculiarities  of  the  valvular  lesions. 

The  changes  in  the  pulse  are  due  to  the  energy  with  which  the 
ventricle  contracts,  and  to  the  low  blood-pressure  in  the  arterial  system. 
The  large  wave  of  blood  rapidly  injected  into  relaxed  vessels  lifts  their 
walls  suddenly,  and  to  a  greater  degree  than  normal  ;  but,  as  consider- 
able quantities  immediately  leak  back  towards  the  ventricle  through 
the  pervious  valves,  the  vessels  again  collapse,  a  fact  which  gives  the 
pulse  its  peculiar  fugitive,  elusive  character.  The  pulse  is  readily 
discovered  by  the  finger  in  all  accessible  arteries,  but  only  in  excep- 
tional cases  can  it   be  seen.     Few  cases  of  "  dancing  of  the  arteries  "~ 


128  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

have  been  chronicled  in  veterinary  Hterature,  the  most  interesting  being 
that  by  Polansky.  To  those  recorded  I  could  add  several,  one  of  which 
I  saw  here  during  the  present  year.  My  assistant  will  read  you  a 
summary. 

Case  i. — A  fourteen-year-old  gelding.  For  some  weeks  the  animal 
had  fed  badly,  shown  difficulty  in  breathing,  and  rapidly  become 
fatigued  during  work.  Examination  of  the  digestive  and  respiratory 
■organs  revealed  nothing  abnormal.  On  auscultation  of  the  heart,  we 
heard  on  both  sides,  but  more  particularly  on  the  left,  a  rough  metallic 
murmur,  beginning  with  diastole  and  extending  throughout  the  whole 
pause  ;  almost  as  distinct  at  the  apex  as  at  the  base  of  the  heart,  and 
extending  above  and  behind  the  latter  as  far  as  the  middle  of  the 
chest.  The  first  sound  and  the  short  pause  were  normal.  The  second 
sound  was  absent. 

The  arterial  circulation  was  greatly  disturbed.  The  pulse  was  very 
strong  at  the  submaxillary,  and  could  readily  be  detected  at  all  the 
superficial  arteries — the  temporal,  masseter,  posterior  auricular,  sub- 
maxillary, radial,  coccygeal,  metacarpal,  and  digital.  At  the  lower 
portion  of  the  jugular  furrow  a  distinct  carotid  pulse  was  seen  at  each 
systole.  The  small  superficial  arteries,  but  especially  the  temporal 
and  metacarpal,  bounded  at  each  contraction  of  the  heart;  there  was 
a  true  "  arterial  dance."  Examination  of  the  aorta  only  revealed 
violent  pulsation,  but  no  murmur. 

With  this  patient  we  only  received  the  following  information  : — 
"  For  some  time  it  had  eaten  less  than  usual,  and  became  fatigued  on 
the  least  exertion."  After  glancing  at  the  buccal  cavity  and  con- 
junctiva, I  examined  the  pulse  at  the  submaxillary;  it  was  strong  and 
bounding.  On  auscultating  the  heart  I  noted  during  the  second  sound 
and  pause  a  rough  metallic  murmur,  most  distinct  at  the  base,  but 
audible  (though  less  clearly)  towards  the  apex  and  along  the  course  of 
the  aorta  for  a  height  of  about  eight  inches.  The  horse  was  suffering 
from  aortic  insufficiency.  Up  to  this  point  the  case  revealed  nothing 
extraordinary,  but,  while  again  taking  the  pulse  at  the  submaxillary,  I 
happened  to  glance  towards  the  temporo-maxillary  articulation,  and 
then  noted  that  each  time  the  submaxillary  dilated  under  my  finger 
the  subzygomatic  visibly  bounded.  The  other  superficial  arteries 
showed  the  same  phenomenon,  especially  the  two  carotids,  at  the 
lower  portion  of  the  jugular  furrows,  and  the  metacarpals.  On  that 
day  I  was  only  able  to  make  a  rapid  examination,  and  unfortunately 
the  patient  was  not  brought  back. 


AORTIC    INSUFFICIENCY    IN    THE    HORSE.  1 29 

Here,  in  very  condensed  form,  are  three  similar  cases  observed 
among  horses  in  hospital,  or  in  the  external  clinique. 

Case  2. — Ten-year-old  entire  horse.  When  submitting  this  animal 
for  examination  the  owner  gave  the  following  information.  The  horse 
was  "soft"  in  work,  soon  got  short  of  breath,  and  stopped  when 
ascending  hills. 

On  auscultating  the  heart  we  noted  a  remarkable  change  in  the 
sounds.  The  first  was  strong,  prolonged,  and  with  a  tendency  to  re- 
duplication. The  apex-beat  was  violent.  The  short  pause  was  followed 
by  a  murmur  which  replaced  the  second  sound,  and  was  prolonged 
throughout  the  long  pause.  This  diastolic  murmur  was  soft,  clearest 
opposite  the  base  of  the  heart,  less  marked  towards  the  lower  parts  of 
the  chest  and  around  the  apex. 

The  pulsations  were  normal  in  number,  the  artery  was  tense,  the 
pulse  very  strong,  bounding,  and  slightly  dicrotic.  The  pulse  could  be 
visibly  counted  at  the  subzygomatic  artery.  It  was  also  very  readil}- 
felt  at  the  digital  artery.  Pulsation  of  the  gluteal  ?  {arterc  fessicre) 
arteries  was  visible  towards  the  centre  of  the  quarter  on  either  side. 
Auscultation  of  the  posterior  aorta  failed  to  reveal  any  abnormal  sound. 
A  jugular  pulse  could  be  detected.     The  animal  was  emphj-sematous. 

Case  3. — A  twelve-year-old  gelding.  For  some  time  the  animal's 
appetite  had  been  bad.  The  driver  stated  that  it  did  not  stop  during 
work,  but  breathed  very  heavily.  On  examining  the  heart  we  detected 
a  murmur  during  the  second  sound,  and  the  pause  was  most  distinctly 
marked  opposite  the  base.  Furthermore,  each  third  heart-beat  was 
followed  by  an  intermittency  lasting  from  three  to  four  seconds.  The 
pulse  was  strong  and  bounding.  It  could  be  seen  at  the  subz\gomatic 
arter}-,  where  the  vessel  passes  under  the  ridge  of  the  maxilla. 

Case  4. — A  mare  about  fifteen  years  old.  A  week  before,  this 
mare,  which  usually  had  an  excellent  appetite,  ate  badly,  and  left  a 
portion  of  her  food. 

Clinical  examination  discovered  no  disturbance  of  the  digestive 
apparatus.  On  auscultating  the  heart  a  strong,  rough,  prolonged 
murmur  was  heard,  to  which  succeeded  a  normal  sound — at  first 
regarded  as  the  second  heart-sound,  but  at  the  moment  that  the 
normal  sound  occurred  the  ear  clearly  perceived  the  sensation  of 
systolic  contraction.  What  had  been  regarded  as  the  second  sound 
was  therefore  in  reality  the  first.     I  heard  in  succession  the  first  sound, 

I 


130  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

the  short  pause,  and  finally  the  murmur  which  covered   the  second 
sound,  and  was  prolonged  throughout  the  long  pause. 

The  pulse  was  very  strong,  but  was  not,  however,  visible  at  the 
superficial  arteries.  By  placing  a  stethoscope  over  the  carotid  towards 
the  lower  part  of  the  neck  a  diastolic  murmur  could  be  heard.  On 
auscultating  the  aorta  no  abnormal  sound  was  detected. 

In  horses  suffering  from  aortic  insufiiciency  the  pulse  is  almost 
always  strong.  You  will  sometimes  find  it  of  normal  volume,  but 
rarely  feeble.  Only  a  moment's  reflection  on  the  changes  produced  in 
the  heart  by  aortic  insufficiency  is  required  to  show  that  the  pulse 
cannot  be  feeble  so  long  as  the  heart  muscle  continues  its  function 
actively. 

Aortic  insufficiency  produces  a  number  of  other  symptoms,  though 
they  are  not  special  to  it.  Like  all  diseases  of  the  heart,  it  is  accom- 
panied sooner  or  later  by  functional  troubles,  the  most  important  of 
•which  are  rapid  loss  of  breath  when  at  work,  dyspnoea,  pain  (causing 
the  animal  to  wear  an  anxious  look),  and  a  tendency  to  vertigo.  When 
animals  are  kept  sufficiently  long,  disturbance  of  the  pulmonary  circu- 
lation may  be  noted ;  passive  congestion  of  the  lung  in  consequence 
of  mitral  insufficiency,  which  again  is  due  to  dilatation  of  the  left 
ventricle,  and  mechanical  enlargement  of  the  auriculo-ventricular 
orifice  ;  later  still,  passive  congestion  of  other  viscera,  resulting  from 
degeneration  of  the  heart  muscle  and  exhaustion  of  the  heart.  But  in 
few  horses  is  the  process  allowed  to  reach  its  last  stage,  the  animals 
usually  being  slaughtered  as  soon  as  they  become  incapable  of  sus- 
tained work. 

Sudden  death  following  arrest  of  the  heart  is  rare  in  horses  with 
aortic  insufficiency,  though  it  may  occur.  I  will  give  you  an  instance. 
Five  or  six  years  ago  a  colleague  asked  me  to  examine  an  old  cart- 
horse, which  he  considered  broken-winded.  At  work  the  animal's 
breathing  soon  became  embarrassed,  especially  when  climbing  hills  and 
during  hot  weather,  but  the  cough  was  not  that  of  emphysema.  On 
auscultating  the  heart  I  diagnosed  aortic  insufficiency,  which  was 
clearly  indicated  by  a  strong  musical  diastolic  murmur.  As  other 
severe  constitutional  symptoms  had  existed  for  a  considerable  time, 
my  prognosis  was  grave.  The  animal  worked  for  a  further  period  of 
three  years.  Several  times  it  fell  down,  but  at  once  rose  again,  gradu- 
ally recovered,  and  after  twenty-four  hours'  rest  resumed  light  work. 
Finally,  one  hot  day,  it  fell  in  the  shafts  and  died  in  a  few  moments. 

The  diagnosis  of  aortic  insufficiency  is  easy.     The  two  symptoms 


AORTIC    INSUFFICIENCY    IN    THE    HORSE.  I3I 

on  which  I  have  laid  stress — the  diastolic  murmur  and  the  bounding 
pulse — are  absolutely  characteristic.  In  certain  cases,  when  the 
heart's  impulse  is  weak  and  the  murmur  very  loud,  it  may  be  regarded 
as  systolic.  I  have  often  corrected  this  error.  In  order  to  avoid  it  one 
need  only  trot  the  animal  for  a  few  moments.  The  impulse  of  the 
heart  becomes  very  marked,  and  no  doubt  can  exist  of  the  diastolic 
character  of  the  murmur.  The  most  useful  indications  may,  however, 
be  wanting.  Some  animals  with  valvular  lesions  and  insufficiency 
continue  work  as  usual  without  showing  dyspnoea  or  weakness  ;  it  is 
not  until  later  that  functional  troubles  attract  attention.  Aortic 
insufficiency  cannot  well  be  mistaken  for  any  other  disease  of  the  heart. 
In  the  horse  insufficiency  of  the  pulmonary  sigmoid  valves  is  extremely 
rare,  and  the  pulse  (which  is  sometimes  small)  differs  entirely  from  that 
of  aortic  insufficiency. 

The  prognosis  is  grave,  not  only  because  the  condition  causes 
immediate  danger  and  may  produce  death  in  a  very  short  time,  but 
because  it  generally  interferes  to  a  large  extent  with  the  animal's  use- 
fulness. As  a  rule  animals  suffering  from  it  pass  successively  into  the 
hands  of  poorer  and  poorer  owners,  who  expect  more  and  more  work. 

Some  lose  condition  rapidly,  others  retain  it  for  a  considerable 
time.  In  all,  the  normal  vigour  and  working  powers  steadily  diminish  ; 
when  the  patients  become  incapable  of  further  work  they  are  usually 
slaughtered.  Most  of  them,  however,  are  sold  and  resold  several  times 
before  death.  This  is  evident  from  animals  being  brought  here  at 
intervals  of  a  few  weeks  after  having  changed  hands.  In  1890  one  was 
thus  brought  on  three  separate  occasions  during  a  single  month.  A 
little  later  we  saw  it  again — this  time  amongst  the  animals  purchased 
for  surgical  exercises. 

Like  all  other  chronic  valvular  changes,  those  of  the  aortic  semi- 
lunar valves  producing  aortic  insufficiency  are  incurable.  Treatment 
is  purely  palliative.  The  principal  drugs  employed  are  the  iodides  of 
potassium  and  sodium,  given  for  periods  of  two  to  three  weeks  ;  and 
when  signs  of  cardiac  failure  appear,  digitalis  and  diuretics. 


XXL— MITRAL   INSUFFICIENCY    IN    THE    HORSE. 

At  the  present  time  we  have  in  stable  No.  4  a  horse  with  mitral 
insufficiency  of  considerable  standing,  in  which  the  clinical  signs  are 
so  well  marked  as  to  leave  no  doubt  regarding  the  prognosis.  Although 
the  horse  is  incurable,  we  have  permission  to  detain  it  for  some  days. 
I  have  particularly  drawn  3'our  attention  to  it,  and  profiting  by  the 
opportunity  offered,  I  intend  this  morning  to  speak  of  chronic  mitral 
endocarditis,  and  to  relate  an  interesting  case. 

The  principal  symptoms  shown  by  our  patient  ma}'  be  summarised 
as  follows  : — A  loud  systolic  murmur  perceptible  over  an  extensive  area 
on  both  sides  of  the  chest,  of  greatest  intensity  towards  the  middle 
portion  of  the  heart,  and  very  clearly  audible  on  applying  the  ear  over 
the  caput  muscles ;  a  feeble,  irregular,  intermittent  pulse,  cardiac 
intermittency  alternating  with  two  or  three  rapid  irregular  heart- 
beats ;  finally,  loss  of  breath  and  dyspnoea  after  a  few  moments'  exercise. 
With  these  facts  before  us  diagnosis  is  easy.  We  have  to  deal  with 
a  case  of  old-standing  mitral  insufficiency  in  which  the  period  of 
compensation  is  past,  and  which  is  complicated  by  changes  in  the 
muscular  tissue  of  the  heart. 

In  the  horse,  chronic  mitral  endocarditis  is  less  frequent  than  aortic 
insufficiency.  Its  aetiology  is  that  of  all  \ah'ular  changes.  With  rare 
exceptions  it  results  from  acute  endocarditis  complicating  certain 
infectious  diseases.  In  solipeds  these  are  generally  represented  by 
strangles,  one  of  the  various  forms  of  pneumonia,  or  b}-  the  typhoid 
form  of  influenza,  which  almost  always  gives  rise  to  acute  endocarditis 
and  to  vah'ular  changes. 

Inflammation  of  the  mitral  vahe  produces  changes  which  finally 
render  it  insufficient ;  the  flaps  become  irregularly  thickened,  contracts 
draw  apart,  and  cease  to  entirely  close  the  opening.  The  chronically 
inflamed  mitral  valves  show  less  varied  and  less  deep  anatomical 
changes    than   the  aortic   valves;    it   is  exceptional  to  see  centres  of 


MITRAL    INSUFFICIENCY    IN    THE    HORSE.  1 33 

degeneration,  vegetations,  aneurisms^  perforations,  partial  ruptures,  or 
adhesion  between  a  flap  and  the  ventricular  wall.  With  the  exception 
of  a  case  of  rupture  of  the  principal  valve,  of  two  others  where  a  small 
aneurismal  depression  existed,  and  of  a  few  cases  of  rupture  of  one  or 
several  of  the  chordae  tendineae,  I  have  never  met  with  anything  moie 
than  sclerotic  changes — thickening,  folding,  and  more  or  less  pro- 
nounced contraction  of  the  valves  of  the  auriculo-ventricular  opening. 

But  the  anatomical  peculiarities  which  mitral  lesions  exhibit  are 
not  of  great  importance  ;  what  dominates  the  after  consequences,  the 
intensity  of  the  symptoms,  and  the  rapidity  of  their  succession  is  the 
degree  of  insufficiency.  Once  insufficiency  is  established,  the  cycle  of 
vascular  troubles  commences.     What  are  these  troubles  ? 

The  mitral  valve  incompletely  closing  the  auriculo-ventricular 
orifice  during  ventricular  systole,  the  blood  makes  its  exit  from  the  left 
ventricle  by  two  orifices  ;  (i)  by  the  normal  aortic  opening,  and  (2)  by 
the  abnormal  auriculo-ventricular  opening,  resulting  from  insufficiency 
of  the  mitral  valve.  At  each  heart-beat  a  portion  of  the  blood  which 
should  pass  into  the  aorta  escapes  by  the  auriculo-ventricular  hiatus, 
and  enters  the  left  auricle.  The  first  effect  of  this  reflux  of  blood 
under  pressure  is  to  dilate  the  affected  auricle,  which,  in  order  to 
overcome  the  distension,  becomes  hypertrophied.  During  a  period 
of  variable  duration,  termed  the  compensation  stage,  matters  rest 
thus,  and  the  primary  lesion  produces  no  functional  disturbance 
likely  to  attract  attention.  At  the  autopsy  of  horses  dead  of  accidents 
or  internal  disease,  lesions  of  the  mitral  valve,  sufficiently  developed  to 
cause  insufficiency,  are  sometimes  found,  without  during  life  having 
attracted  any  attention  whatever.  Up  to  the  last  moment  the  animals 
have  been  able  to  perform  ordinary  work. 

Here  is  a  case  of  compensated  mitral  insufficiency  seen  in  a  horse 
which  died  from  rupture  of  the  stomach. 

A  ten-year-old  Percheron  horse,  which  had  worked  very  hard  for 
some  years,  but  the  general  condition  of  which  had  always  been  satis- 
factory and  the  health  good,  was  brought  to  the  College  on  account  of 
impaction  of  the  stomach,  from  which  it  finally  died.  At  the  post-inorteni 
examination  we  found,  in  addition  to  ruptured  stomach,  an  enlarged 
heart.  The  left  auricle  was  greatly  dilated  and  its  walls  thickened. 
On  opening  the  left  ventricle  we  detected  old-standing  mitral  lesions. 
The  anterior  and  the  left  valves  were  little  changed,  but  the  principal 
flap  was  thickened  and  contracted,  and  exhibited  at  its  right  extremity 
an  irregular  fibrous  vegetation;  the  right  valve  was  shrivelled,  and 
showed  near  its  free  borders  a  large  hardened  area.  The  right  heart 
was    normal.      These    mitral    lesions   certainly   caused    insufficiency. 


134  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

Nevertheless  the  animal  had  been  able  to  regularly  perform  trotting^ 
work  up  to  the  day  of  its  death.  Although  the  mitral  changes  were  of 
old  standing,  they  had  been  compensated.  The  increased  functional 
acti\ity  of  the  left  auricle  had  proved  sufficient  to  overcome  the  obstacle 
resulting  from  the  valvular  lesion,  and  to  prevent  the  appearance  of 
symptoms  which  would  have  betrayed  the  altered  conditions. 

As  a  rule,  this  phase  of  mitral  insufficiency,  where  regurgitation  of 
blood  is  confined  to  the  left  auricle,  is  not  of  long  duration.  The 
pulmonary  veins  soon  become  engorged  and  dilated ;  stasis  gradually 
extends  to  the  pulmonary  capillaries,  the  main  arterial  trunks  of 
the  pulmonic  circulation,  and  the  right  ventricle.  In  turn  the  right 
ventricle  becomes  distended,  with  or  without  its  walls  hypertro- 
ph5^ing ;  then,  on  account  of  the  tricuspid  insufficiency  which  follows, 
the  right  auricle  undergoes  similar  changes.  These  disturbances 
extend  to  the  veins  of  the  greater  circulation,  to  the  portal  system, 
to  the  systemic  capillaries  and  to  the  whole  arterial  system.  The 
increased  tension  in  the  latter  is  finally  felt  in  the  left  ventricle, 
which,  being  overworked,  becomes  dilated  and  to  a  certain  extent 
hypertrophied. 

Such  is  the  cycle  of  troubles  produced  by  mitral  insufficiency. 
The  heart  is  their  point  of  origin,  and  the  object  on  which  in  the  last 
instance  they  react.  But  very  rareh'  indeed  are  they  alloN\ed  to 
develop  in  their  entirety  in  working  animals,  the  patient  being  almost 
always  destroyed  when  incapable  of  further  work,  that  is,  as  soon  as 
blood-stasis  in  the  pulmonary  capillaries  produces  grave  respiratory 
disease. 

Let  us  now  consider  the  changes  which  occur,  first  in  the  lung 
and  then  in  the  other  viscera,  under  the  influence  of  blood-stasis. 

The  effects  produced  by  dilatation  of  the  pulmonar}-  vessels  and 
retardation  of  the  blood-current  through  them  grow  rapidly  in  im- 
portance. The  capillaries  become  varicose,  their  walls  thinned,  and 
the  nutrition  of  the  cells  composing  them  suffers.  Congestion  of  the 
bronchial  mucous  membrane  follows  distension  of  the  pulmonary 
capillaries,  and  b}-  diminishing  the  calibre  of  the  air  conduits  tends 
to  produce  dyspnoea.  Blood-plasma  filters  through  the  thin  vessel 
walls  and  becomes  extravasated,  partly  into  the  alveoli,  parti}'  into  the 
pulmonary  tissue  itself.  In  time  pulmonar)-  oedema  increases  :  in 
places  induration  may  occur,  and  disseminated  centres  of  interstitial 
pneumonia  appear.  The  respirator}-  surface  is  thus  considerably 
diminished,  oxygenation  of  the  blood  becomes  very  imperfect,  and 
dyspnoea  follows. 

As  soon  as  general  venous  stasis  occurs   internal  organs  become 


MITRAL    INSUFFICIENCY    IN    THE    HORSE.  1 35 

cong^ested,  transudation  takes  place  into  the  splanchnic  cavities,  and 
cedema  appears  about  the  lower  portions  of  the  body. 

In  consequence  of  its  position  close  to  the  heart,  and  of  the  rich- 
ness and  peculiar  arrangement  of  its  vascular  supply,  the  liver  is  the 
first  of  the  viscera  to  be  affected.     Stasis  in  the  posterior  vena  cava 
first  reacts  on  the  hepatic  and  intra- lobular  veins,  then  on  the  capil- 
laries and  interlobular  or  perilobular  vessels.     In  the  first  stage  the 
changes  are  simply  congestive  ;  the  liver  is  very  large  and  engorged 
with    blood,   and   incisions  show  a  marbled    appearance,  a  crowd  of 
little  blackish  points  being  scattered  over  a  lighter  ground.     All  the 
lobules  show  the  same  abnormal  appearance  ;  the  central  portion,  dark 
in  colour,  is  formed  by  the  enlarged  orifice  of  the  intra-lobular  vein ; 
the  periphery  is  whitish  or  greyish  white.     To  this  peculiar  modifica- 
tion of  the  hepatic  tissue,  seen  in  old-standing  diseases  of  the  heart, 
has  been  given  the  name  of  cardiac  or  nutmeg  liver.     The  microscope 
shows  dilatation  of  the  intra-lobular  veins,  enlargement  of  the  capil- 
laries,   and    more    or   less    pronounced    compression    of  the    hepatic 
trabeculse    throughout    the    entire    area    of  the  lobules.     At  a  more 
advanced  stage  inflammatory  supplement  the  preceding  phenomena. 
Examined  with  the  naked  eye  the  liver  is  still  large,  consistent,  and 
spotted.     The  microscope  reveals  diffuse  sclerotic  lesions,  both  in  the 
inter-  and  intra-lobular  regions,  the  walls  of  the  intra-lobular  veins  are 
thickened,  and  appear  as  though  surrounded  by  a  connective-tissue 
sheath  ;  the  portal  spaces  are  slightly  enlarged  by  trifling  hyperplasia 
of  the  same  character,  which  in  time  may  extend  to  the  entire  peri- 
phery' of  the  lobules.     Deformed  first  of  all  by  dilatation  of  the  hepatic 
capillaries,  and  then  compressed  by  this  double  series  of  new  growths 
within  and  around  the  lobules,  the  hepatic  cells  undergo  fatty  degene- 
ration.    Does  hepatic  congestion  of  cardiac  origin  in  the  horse  ever  end 
in  rupture  of  the  liver?     This  has  been  affirmed,  and  some  cases  have 
been   recorded.       In  the  post-iuortcm    examinations   I   have  made  the 
liver  has  always  appeared  simply  congested,  or  firm,  consistent,  and 
more  or  less  cirrhotic.     Where  rupture  has  occurred   in  horses  with 
heart  disease  it  seems  possible  that  special  degenerative  changes  had 
existed  side  by  side  with  those  due  to  circulatory  disturbance.     This 
point  has  not  yet  been  carefully  studied. 

Although  much  less  pronounced  than  those  of  the  liver,  the  changes 
undergone  by  the  intestine  and  stomach  are  not  less  evident.  As 
soon  as  the  portal  circulation  is  impeded  the  mucous  membrane  of 
these  organs  becomes  passiveh'  congested,  the  muscular  tissue  loses 
power  and  acts  less  energetically,  and  gastro-intestinal  catarrh  may 
develop.      Like  the  liver,  the  spleen  first  shows  simple  passive  con- 


136  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

gestion,  but  later  inflammation  occurs,  producing  new  connective- 
tissue  growth  and  sclerotic  changes.  The  capsule  becomes  thickened 
in  places,  or  covered  with  little  fibrous  tufts. 

The  kidneys  are  affected  in  their  turn  by  the  stasis  in  the  vena 
cava,  but  at  first,  and  for  a  certain  time,  only  show  congestive  changes. 
They  are  slightly  larger  and  of  deeper  colour  than  usual ;  but  even  at 
this  stage  the  microscope  may  show  proliferation  of  the  epithelium 
lining  the  straight  tubules.  At  a  later  period  interstitial  nephritis 
here  and  there  produces  atrophy  of  the  uriniferous  tubules,  and  forma- 
tion of  tracts  of  fibrous  tissue,  contraction  of  which  renders  the  surface 
of  the  organ  irregular  and  knobby.  In  sections  of  this  "cardiac 
kidney"  the  Malpighian  tufts  appear  injected  and  slightly  prominent. 
At  certain  points  the  tissue  is  hardened,  whitish  in  colour,  and  of 
lardaceous  appearance. 

A  time  arrives  when  the  various  organs,  including  the  brain  and 
spinal  cord,  and  all  vascular  tissues  feel  the  effects  of  this  distension  of 
the  general  venous  system  ;  but  dropsy,  oedema,  and  inflammation  of 
the  meninges,  generalised  hardening  of  extensive  tracts  of  tissue  and 
skin  lesions  are  final  complications  which  only  appear  at  a  very  late 
period.  Ascites,  hydrothorax,  and  hydropericardium  are  usually  too 
little  marked  to  be  recognised  during  life.  Changes  in  the  blood, 
such  as  diminution  in  red  blood-corpuscles,  and  alteration  of  the 
plasma,  also  belong  to  the  group  of  later  complications.  They  slowly 
become  more  marked,  and  lead  to  cardiac  cachexia. 

Whether  chronic  mitral  endocarditis  follow  acute  inflammation,  or 
appear  as  a  primary  condition,  its  onset  is  always  insidious  ;  even 
when  the  mitral  valve  is  contracted  and  insufficient,  no  special  dis- 
turbance may  exist  to  attract  attention,  provided  the  insufficiency  is 
compensated. 

This  latent  period  terminates  as  soon  as  the  lungs  become  en- 
gorged. Then  the  patients  rapidly  lose  breath  at  work,  and  show 
symptoms  which  are  usually  referred  to  broken  wind.  Many  fail  to 
come  under  the  veterinary  surgeon's  notice  until  an  advanced  stage, 
when  the  symptoms  are  already  so  numerous  as  immediately  to  suggest 
heart  disease.  Moreover  the  animal's  history  is  often  sufficient  to  arouse 
such  suspicion.  When  examining  an  animal  apparently  in  health, 
but  the  history  of  which  tells  of  weakness,  diminished  capacity  for 
work,  sweating,  rapid  loss  of  breath  after  moderate  exercise,  lying 
down  immediately  on  returning  to  the  stable,  capricious  appetite,  or 
total  loss  of  appetite  ;  then,  provided  these  symptoms  have  existed  for  a 
certain  time,  one  should  suspect  heart  disease  whatever  the  animal's  age. 


MITRAL    INSUFFICIENCY    IN    THE    HORSE.  I37 

The  two  principal  signs  of  mitral  insufficiency  are  a  systolic 
murmur  and  feebleness  and  small  size  of  the  pulse.  On  auscultat- 
ing the  heart  one  hears  a  murmur  commencing  with  systole,  covering 
the  short  pause,  and  ending  with  the  second  sound  ;  the  latter  and  the 
long  pause  are  usually  normal.  This  murmur  may  extend  not  only 
over  the  base,  centre,  and  apex  of  the  heart,  but  over  a  considerable 
area  of  the  surrounding  parts.  It  is  clearly  a  mistake  to  say  that  it  is 
heard  most  loudly  over  the  apex.  Being  due  to  reflux  of  blood  from 
the  left  ventricle  into  the  auricle,  it  is  produced  in  the  auriculo- 
ventricular  opening,  which  is  situated  about  one  and  a  quarter  inches 
below  the  aortic  orifice,  and  about  six  to  eight  inches  from  the  apex. 
The  point  of  maximum  intensity  corresponds  to  the  depression 
in  the  left  pulmonary  lobe,  or  to  the  mesocardiac  zone.  Like 
the  aortic  murmur,  it  varies  greatly  in  strength  and  tone,  depending 
on  the  degree  of  insufficiency  and  on  the  existence  or  absence  of 
vegetations  on  the  valvular  flaps.  The  configuration  of  the  margins  of 
the  valve  changes  as  the  process  develops,  and  the  character  of  the 
murmur  may  thus  undergo  modification  at  uncertain  intervals.  In 
one  horse  which  I  kept  under  observation  the  sound  was  at  first  soft, 
afterwards  harder  and  vibrating.  As  in  the  case  of  diastolic  murmurs, 
the  modification  in  character  of  systolic  murmurs  bears  no  relation  to 
the  changes  in  the  valvular  condition  as  determined  by  post-mortem 
examination.  All  one  can  say  is  that  soft  murmurs  usually  denote 
either  trifling  or  very  large  insufficiencies,  and  rough  strong  murmurs 
insufficiencies  of  moderate  extent. 

The  pulse  of  mitral  insufficiency  contrasts  with  that  of  aortic 
insufficiency.  Whilst  in  the  latter  the  pulsations  are  strong  and 
bounding,  in  the  former  they  are  feeble,  often  almost  indistinguishable 
or  uncountable.  At  the  moment  of  ventricular  contraction  one 
portion  of  the  blood  contained  in  the  left  ventricle  escapes  by  the 
mitral  orifice  ;  only  a  small  wave  enters  the  aorta,  scarcely  lifting  the 
arterial  wall,  and  the  pulse  is  invariably  small.  For  a  long  time  no 
other  change  is  apparent  ;  but  when  the  valvular  lesion  has  reacted  on 
the  heart  muscle  a  want  of  rhythm  becomes  apparent  ;  the  cardiac 
contractions  and  the  pulse  at  first  become  unequal  ;  later,  inter- 
mittences  occur,  alternating  with  the  series  of  normal  heart-beats.  In 
one  ot  the  patients  of  which  I  have  spoken  disturbance  of  the  circula- 
tion could  be  detected,  pointing  to  change  in  the  heart  muscle  or  to  a 
cardiac  complication  of  the  mitral  disease. 

The  other  symptoms  which  occur  result  from  stasis  of  blood  in  the 
viscera.  Passive  congestion  of  the  lung  produces  oppression,  dyspnoea, 
cough,  and  later  bronchorrhcea.       In  some  subjects  reflex  disturbance 


138  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

is  brought  about  through  the  medium  of  the  pneumogastric  nerve,  as 
shown  by  irregular  or  complete  loss  of  appetite,  anxiety,  somnolence, 
or  depression.  Transudates  in  the  large  serous  cavities,  oedema  of  the 
lower  portions  of  the  body,  intestinal  catarrh,  icterus,  and  albuminuria 
only  appear  at  an  advanced  stage. 

I  may  repeat  that  chronic  mitral  endocarditis  with  complications 
due  to  stasis  in  the  veins  of  the  systemic  circulation  is  rarely  seen,  the 
patients  not  being  kept  sufficiently  long  for  such  remote  complications 
to  occur.  Last  summer,  however,  we  saw  a  case  which  I  will  recall  to 
you. 

In  the  month  of  June  a  farmer  at  Bonneuil  sent  us  a  horse,  bought 
the  preceding  year,  which  for  months  had  appeared  in  good  health, 
but  about  six  weeks  before  had  begun  to  fall  away  in  condition,  and 
had  up  to  that  time  lost  about  100  lbs.  in  weight.  One  day  an  oede- 
matous  swelling  was  seen  under  the  chest,  but  nothing  else  being 
observed  no  precautions  were  taken,  and  the  horse  drawing  a  heavy 
wagon  set  out  from  Bonneuil  for  Maisons-Alfort.  During  the  journey 
it  frequently  stopped  for  want  of  breath,  and  was  thrashed  by  the 
brute  who  drove  it.  On  returning  to  the  stable  it  lay  down  without 
touching  its  food. 

The  morning  after  it  was  brought  to  the  clinique.  It  was  very  thin 
and  depressed  ;  the  mucous  membranes,  and  especially  the  conjunctivae, 
were  pale.  The  respiration  was  rapid,  irregular,  and  showed  a  well- 
marked  double  expiratory  effort ;  but  the  cough  was  strong  and  loud, 
in  no  way  resembling  that  of  emphysema. 

Percussion  of  the  chest  revealed  diminished  resonance  in  the  lower 
third,  especially  on  the  left  side.  On  auscultation  the  respiratory  mur- 
mur was  feeble.  The  heart  beat  rapidly,  and  on  examination  two 
murmurs  could  be  heard,  one  systolic,  the  other  diastolic  ;  while  irregu- 
lar intermittences  lasting  for  one  or  two  pulsations  could  be  detected. 
Certain  of  the  contractions  were  bounding,  and  gave  a  distinct  impulse 
to  the  thoracic  wall.  The  pulse  was  small,  unequal,  and  intermittent. 
The  pulsations  of  the  posterior  aorta  corresponded  to  the  beating  of 
the  heart,  were  unequal,  and  70  to  76  per  minute.  Each  heart-beat 
produced  an  aortic  pulsation,  but  the  more  feeble  were  not  transmitted 
to  distant  arteries.  The  jugulars  were  prominent,  and  showed  a  pulse 
synchronous  with  the  heart.  The  swelling  under  the  chest  had  almost 
disappeared.  The  temperature  was  normal.  The  urine  contained 
neither  albumen  nor  sugar. 

These  symptoms,  the  known  frequence  of  left  heart  disease  in 
the  horse,  the  absence   of  the  arterial   sign  of  aortic  insufficiency — 


MITRAL    INSUFFICIENCY    IN    THE    HORSE.  1 39. 

Corrigan's  pulse, — and  the  signs  of  dyspnoea  produced  by  a  few  minutes' 
exercise,  led  me  to  diagnose  old-standing  mitral  endocarditis  with 
insufficiency.  On  the  other  hand,  the  diastolic  murmur,  the  ver}' 
marked  venous  pulse,  and  the  cedema  indicated  dilatation  of  the  right 
heart,  with  reflux  and  stasis  of  blood  in  the  vessels  of  the  systemic 
circulation. 

I  kept  this  case  for  a  time  to  afford  you  an  opportunity  of  following 
the  course  of  the  disease.  At  the  end  of  a  week  the  hind  limbs 
became  swollen.  The  lower  surface  of  the  abdomen  and  of  the  chest 
showed  extensive  cedema. 

The  animal  was  slaughtered.  The  principal  lesions  found  on  post- 
mortein  examination  were  as  follows : — The  abdominal  cavities  con- 
tained some  quarts  of  a  yellowish  limpid  serosity  without  fibrinous 
flocculi.  The  veins  of  the  systemic  circulation  were  dilated.  Over 
almost  its  entire  surface,  but  especially  along  the  course  of  its  vessels, 
the  large  colon  showed  abundant  subserous  oedema.  The  liver  was 
very  large  ;  on  incision  the  condition  known  as  "cardiac  liver"  was 
seen  to  be  well  developed.  The  other  abdominal  viscera,  especially 
the  kidneys  and  spleen,  were  engorged  with  blood. 

The  pleural  cavities  contained  4  to  5  quarts  of  serous  fluid,  resem- 
bling that  in  the  peritoneum.  The  lung  was  blackish,  heavy,  and 
congested  ;  its  tissue  was  in  some  places  oedematous,  in  others  dense 
and  sclerosed.  The  heart  was  enormous  ;  the  right  heart  especially 
had  become  enlarged  ;  its  cavities  were  greatly  dilated,  the  auricle 
being  almost  four  times  its  normal  capacity.  The  left  auricle  was  also 
much  dilated,  and  the  walls  of  the  corresponding  ventricle  (which  were 
slightly  hypertrophied)  showed  areas  of  sclerosis.  The  flaps  of  the 
mitral  valve,  more  particularly  the  principal,  were  thickened,  shortened, 
puckered,  and  at  certain  points  of  ahiiost  cartilaginous  consistence. 

The  course  of  the  morbid  condition  produced  by  mitral  lesions  is 
fatally  progressive.  Whether  or  not  insufficiency  be  complicated 
by  contraction,  the  circulation  gradually  becomes  impeded,  and  the 
resulting  symptoms  more  marked  ;  the  general  condition  steadily 
increases  in  gravity,  until  at  last  death  terminates  the  case. 

Chronic  mitral  endocarditis  being  in  the  long  run  fatal,  how  does 
death  occur  ? 

Mitral  lesions  usually  kill  slowly.  Among  the  organs  (which  are 
all  gravely  affected)  two,  the  heart  and  lung,  still  actively  continue 
their  functions.  Though  first  affected,  overloaded  in  the  beginning, 
and  in  the  last  stages  burdened  with  the  ever-increasing  arterial 
tension,  the  heart  continues  to  struggle  against  the  growing  vascular 


140  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

obstruction,  which  finally  reacts  on  the  left  ventricle.  In  the  lung  the 
useful  respiratory  surface  becomes  more  and  more  reduced ;  the 
oedema,  inflammation,  and  obliteration  of  capillaries  steadily  diminish- 
ing the  small  number  of  pulmonary  alveoli  still  capable  of  carrying  on 
oxygenation  of  blood.  Toxic  blood  completes  the  disorganisation 
produced  by  mechanical  disturbance.  The  heart,  already  exhausted, 
is  arrested  by  the  increasing  asphyxia. 

At  advanced  stages  of  mitral  disease  death  may  occur  rapidly  by 
another  process.  On  account  of  the  slowness  of  circulation  coagula- 
tion may  occur  in  the  arteries  of  organs  essential  to  life.  This  explains 
how  patients  sometimes  die  in  a  few  days,  in  a  few  hours,  indeed  in  a 
few  moments,  either  from  thrombosis  of  the  coronary  arteries  or  from 
thrombosis  or  embolism  of  the  pulmonary  artery.  Sudden  death, 
however,  is  rarer  than  in  aortic  insufficiency. 

The  diagnosis  of  mitral  insufficiency  offers  little  difficulty  in  the 
horse.  Tricuspid  insufficiency  (which  is  much  less  common)  is  almost 
-always  brought  on  by  dilatation  of  the  right  heart,  consequent  on 
chronic  pulmonary  affections,  especially  old-standing  emphysema.  It 
is  soon  accompanied  by  a  well-marked  venous  pulse,  and  the  tricuspid 
systohc  murmur,  usually  softer,  less  prolonged  than  the  mitral  sound, 
is  also  heard  at  a  more  anterior  point.  With  a  little  practice,  no 
mistake  need  be  made  between  this  and  the  diastolic  murmur  of  aortic 
insufficiency.  The  presystolic  murmur  produced  by  mitral  contraction 
is  extremely  rare. 

What  I  have  already  said  of  the  course  of  the  disease  will  guide 
you  in  prognosis,  which  is  of  extreme  gravity.  No  improvement  is 
possible,  nor  can  the  development  of  the  cardiac  lesions  or  the  accidents 
which  follow  in  their  train  be  arrested.  You  have  seen  that  irregularities 
of  the  heart  and  pulse  add  to  the  gravity  of  prognosis.  When  they 
appear,  the  heart  has  undergone  a  secondary  change,  either  in  its 
muscular  tissue  or  in  its  nervous  apparatus. 

The  treatment  of  mitral  insufficiency  is  of  little  interest.  As  soon 
as  the  compensation  period  is  over,  the  animal  is  slaughtered,  or 
passes  into  fresh  hands. 

Even  when  the  disease  is  recognised  in  its  eusystolic  stage,  before 
actual  organic  change  has  occurred,  the  various  drugs  recommended 
are  useless.  The  most  reasonable  treatment  consists  of  rest,  moderate 
exercise,  and  good  hxgienic  surroundings — treatment  inapplicable  to 
working  animals. 

At   the   asystolic  stage   the  drugs  indicated   are   those   capable  of 


MITRAL    INSUFFICIENCY    IN    THE    HORSE.  I4I 

rendering  the  heart  equal  to  its  increased  task.  DigitaUs  is  of  service, 
but  given  before  the  proper  time — that  is  to  say,  when  the  mitral 
lesion  is  still  compensated — -digitalis  is  often  injurious;  it  increases  the 
work  of  the  heart  without  purpose,  fatigues  the  muscular  tissue,  and 
may  finally  bring  about  degenerative  changes.  Under  certain  circum- 
stances, bromide  and  iodide  of  potassium  or  sodium  may  be  given  to 
combat  cardiac  asthma  and  sclerotic  changes — ^purgatives  and  diuretics 
are  indicated  in  oedema  and  drops}-. 


XXII.— MYOCARDITIS. 

In  animals,  and  particularly  in  the  horse,  inflammation  of  the 
myocardium,  either  acute  or  chronic,  is  much  more  frequent  than 
might  be  supposed  from  the  small  number  of  published  cases.  Our 
present  knowledge  on  this  subject  is  still  very  defective,  especially  from 
the  clinical  point  of  view,  because,  as  I  shall  almost  immediately  show 
you,  myocarditis  is  characterised  by  less  striking  symptoms  than 
endocarditis  and  pericarditis,  and  because  many  cases  having  only  been 
diagnosed  on  post-mortem  examination,  the  observers  have  necessarily 
been  restricted  to  describing  the  anatomical  lesions. 

The  specimens  which  I  place  before  you  may  be  separated  into 
two  groups :  one,  illustrating  the  changes  in  acute  myocarditis,  are 
derived  from  horses  dead  of  various  infectious  diseases, — usually,  how- 
ever, contagious  pneumonia ;  the  others,  showing  lesions  of  chronic 
myocarditis,  have  almost  all  been  obtained  during  post-mortem  exami- 
nation of  animals  used  for  the  exercises  in  practical  surgery. 

Among  these  are  two  in  which  the  anatomical  and  pathological 
characteristics  of  the  two  great  varieties  of  myocarditis  are  typical, 
though  excessively  pronounced. 

First  of  all  I  show  you  the  heart  of  a  horse  dead  of  contagious 
pneumonia  on  the  eleventh  day,  in  which  gangrene  of  both  pulmonary 
lobes  existed  as  a  complication.  It  is  very  large — weighs  more  than  eight 
and  a  half  pounds,  and  has  been  the  seat  of  acute  diffuse  myocarditis. 
It  shows  large  yellowish  patches,  irregularly  distributed,  but  principally 
occupying  the  left  ventricle  and  auricle.  On  the  left  ventricle,  starting 
from  the  auriculo-ventricular  furrow,  is  a  large  zone  of  fatty  degenera- 
tion, measuring  from  one  and  a  half  inches  to  three  inches  in  width, 
according  to  the  point  selected,  and  sharply  differentiated  from 
adjacent  tissues  by  its  yellow  colour.  Sections  through  the  wall  and 
cardiac  septum  vary  in  colour  from  brown  to  red,  grey,  or  yellow, 
according  to  the  point  chosen.  Small  hsemorrhagic  centres  also  exist. 
Several  large  areas  of  degeneration  extend  through  the  entire  thickne>=s 


Heart  of  a  horse  which  died  from  contagious  pneumonia.  Acute  myocarditis. 


MYOCARDITIS. 


143 


of  the  ventricular  wall.  The  pericardium  and  endocardium  are  hardly 
affected.  On  macroscopic  examination  the  valves  show  no  appreci- 
able lesion,  but  microscopic  examination  reveals  lesions  of  acute  diffuse 
myocarditis.  Even  where  the  myocardium  appears  least  altered  its 
fibres  prove  to  have  undergone  granular  degeneration. 

In  the  other  specimen  we  see  advanced  lesions  of  chronic  myocar- 
ditis. This  heart  is  moderately  hypertrophied,  and  exhibits  scattered, 
whitish,  irregular,  more  or  less  depressed  areas,  some  isolated,  others 
united  by  narrow  bands  of  the  same  colour  ;  the  largest  are  seen  on  the 
left  ventricle,  principally  about  the  auriculo-ventricular  furrow.  Sec- 
tions through  the  wall  of  this  \entricle  reveal  similar  whitish  areas, 
fibrous  in  appearance,  star-shaped,  isolated  or  united.  At  these  points 
the  myocardium  has  undergone  a  fibrous  change  and  the  muscular 
fibres  have  disappeared,  having  become  atrophied  or  affected  with 
granular  degeneration  under  the  compression  exercised  by  the  fibrous 
tissue.  In  addition  the  aortic  semilunar  valves  show  old-standing 
change. 

Acute  or  chronic  infiammation  of  the  myocardium  is  usually  diffuse, 
extends  to  the  greater  part  of  the  muscle,  and  is  in  most  cases 
unequally  marked  in  the  left  and  right  hearts,  the  former  being  com- 
monly the  most  markedly  affected.  This  inflammation  sometimes 
occurs  as  an  isolated  affection,  without  co-existent  changes  in  the  endo- 
cardium or  pericardium  ;  more  frequently  myocarditis  is  accompanied 
by  endocarditis  or  endopericarditis,  facts  explained  by  the  general 
pathogeny  of  heart  disease,  the  muscle  and  serous  membranes  covering 
it  being  simultaneously  attacked  by  the  same  infectious  or  toxic  agent. 

Acute  myocarditis  has  been  divided  into  primary  and  secondary. 
The  first  is  stated  to  be  produced  by  cold,  over-exertion,  or  mechanical 
injury.  Apart  from  infection  or  rheumatism,  myocarditis  a  frigore 
cannot  be  said  to  occur.  Deepl}'  placed  in  the  thorax,  the  heart  is  one 
of  the  organs  least  susceptible  to  the  action  of  cold,  which,  at  the  most, 
only  favours  other  agents  capable  of  injuring  the  myocardium.  Some 
cases  in  man  seemed  to  prove  the  occurrence  of  lesions  of  the  myo- 
cardium and  endocardium  after  excessive  and  prolonged  efforts.  Similar 
cases  have  also  been  observed  in  creatures  used  for  draught,  the  horse 
particularly ;  but  although  the  horse  is  probably  the  hardest  worked  of 
all  animals,  it  is  very  doubtful  if  it  ever  suffers  from  myocarditis  due 
exclusively  to  excessive  work.  Recent  investigations  have  explained 
the  pathogenv  of  that  form  of  myocarditis  which  follows  excessive 
exertion  of  the  cardiac  muscle.  Contrary  to  the  views  formerly  held, 
we    now    believe    that    excessive    exertion    does    not    directly    produce 


144  CLINICAL    VETERIXARV    MEDICINE    AND    SURGERY. 

inflammation  of  the  muscular  tissue  of  the  heart,  but  onl}-  diminishes 
its  resistance  to  the  attacks  of  pathogenic  organisms — a  theory  strongly 
corroborated  by  bacteriological  experiments  made  during  the  past  few- 
years,  especially  by  those  of  M.  Roger.  Myocarditis  due  to  "  over- 
exertion "  is  therefore  included  in  the  group  of  infectious  m}-ocardites. 

Mechanical  injury  of  the  thorax  over  the  heart  only  causes  inflam- 
mation of  the  cardiac  muscle  when  a  penetrating  wound  is  produced, 
or  when  the  muscle  itself  is  immediately  injured,  and  the  lesion  be- 
comes infected. 

I  have  only  observed  acute  myocarditis  in  the  horse  as  a  secondary 
affection  ;  nor  have  I  seen  its  characteristic  lesions,  except  in  animals 
which  had  died  of  toxic  or  infectious  disease,  and  in  which,  conse- 
quently, myocarditis  had  occurred  as  a  complication  of  the  original 
disease.  The  various  forms  of  pneumonia,  the  typhoid  form  of 
influenza,  strangles,  hctmoglobinuria,  septicaemia,  p3-gemia,  and  other 
microbic  diseases  may  be  accompanied  b}'  myocarditis,  either  be- 
cause of  pathogenic  organisms  dispersed  by  the  blood-stream 
arriving  at  the  myocardium  through  the  medium  of  the  coronary 
arteries,  and  arrested  there,  producing  embolism  of  more  or  less 
extensive  tracts;  or  even  more  frequentl}-  because  of  injury  to  the 
myocardium  by  the  toxins  of  microbes  multiplying  at  a  distant  point. 
M.  Charrin  produced  myocarditis  in  animals  b}-  injecting  filtered 
cultures  free  of  all  li\ing  organisms ;  but,  whether  infectious  or  toxic, 
these  forms  of  myocarditis  are  primarily  due  to  the  life  processes  of 
microbes. 

Diffuse  or  localised  m30carditis,  whether  limited  to  the  deep  or 
superficial  layers  of  muscle,  always  results  from  the  extension  of  inflam- 
mation from  the  endocardium  or  epicardium.  They  show  that  Stokes's 
law  on  extension  of  inflammatory  processes  from  mucous  membranes 
to  subjacent  muscles  also  holds  true  in  regard  to  serous  membranes. 

The  changes  produced  in  the  heart  muscle  by  acute  diffuse  inflam- 
mation are  usually  well  marked,  and  (juite  apparent  on  superficial 
examination,  though  seldom  to  such  an  extent  as  in  the  specimen  I 
exhibit,  where  they  are  truly  remarkable.  Usually  the  heart  is  more 
or  less  enlarged,  dilated,  flabby,  and  decolourised.  Sometimes  its 
surface  is  almost  uniforml}-  pale  gre}-ish,  or  the  colour  of  a  dead  leaf; 
sometimes  it  is  marked  with  yellowish  patches  of  varying  form  and 
size,  the  majorit}-  irregular  in  shape,  with  sharply  defined  margins, 
and  usually  more  numerous  and  larger  in  size  on  the  ventricles. 
Under  the  epicardium  and  endocardium  little  hsemorrhagic  centres 
can  be  seen.     Sections  made  through  the  myocardium  appear  of  a  dull 


MYOCARDITIS.  1 45 

leaden  colour,  or  the  muscular  tissue  is  slightly  infiltrated,  and  of  the 
same  tint  as  the  surface  of  the  organ  ;  on  the  more  or  less  discoloured 
base  are  scattered  greyish -yellow  patches  and  a  few  blackish  areas  or 
points,  the  former  corresponding  to  centres  of  degeneration,  the  others 
to  haemorrhages. 

On  microscopic  examination,  inflammatory  and  other  degenerative 
esions  are  seen.  Many  of  the  fibres  appear  swollen,  fusiform  in  shape, 
and  slightly  granular  ;  their  striation  is  less  marked  than  normal,  or 
may  be  altogether  lost.  Of  the  interstitial  lesions,  the  chief  is  hyper- 
aemia  and  infiltration  with  leucocytes.  At  a  later  stage  the  affected 
fibres  undergo  granular,  fatty,  or  hyaline  degeneration,  become  sepa- 
rated, more  or  less  filled  with  fine  granulations,  or  parti}-  broken  down, 
while  signs  of  obliterating  endarteritis,  or  periarteritis,  and  abundant 
cellular  infiltration  may  be  seen.  As  a  rule  these  lesions  are  difi"use, 
and  irregularly  distributed ;  alongside  degenerated  fibres  others  are 
sometimes  found  which  have  remained  healthy,  or  appear  scarcely 
changed. 

In  purulent  myocarditis  section  of  the  muscle  exposes  little  ab- 
scesses disseminated  throughout  its  substance.  They  are  generally 
metastatic,  and  due  to  embolism,  as  in  other  viscera.  They  may  also 
be  the  direct  consequence  of  infectious  inflammation  of  the  cardiac 
muscle,  in  which  case  they  are  not  found  in  other  organs.  The  tissue 
surrounding  them  is  markedly  hyperaemic,  infiltrated,  and  softened. 
Superficial  abscesses  may  break  into  the  interior  of  the  heart,  or  into 
the  pericardium.  Cases  of  complete  perforation  of  the  septum  be- 
tween the  ventricles,  by  abscesses  developed  in  its  thickness,  have 
been  published. 

In  a  general  sense  the  symptoms  of  acute  myocarditis  all  point  to 
enfeeblement  of  the  heart.  Nevertheless,  at  first  symptoms  of  irrita- 
tion almost  always  occur.  There  is  a  period  of  abnormal  irritability  ; 
the  heart  beats  faster  and  more  strongly ;  sometimes  the  contractions 
are  violent,  rapid,  and  tumultuous ;  the  pulse  is  accelerated  and 
strong ;  the  respiration  short,  and  suggestive  of  dyspnoea. 

The  local  changes  gradually  develop,  and  the  vague  early  symptoms 
are  exchanged  for  others  of  a  precise  character.  The  heart  beats  more 
slowly  and  feebly,  and  is  often  irregular  or  intermittent.  Little  by 
little  the  first  sound  diminishes  in  intensity  until  it  becomes  scarcely 
perceptible.  The  second  sometimes  remains  normal,  sometimes  it 
also  diminishes.  In  certain  patients  a  slight  systoHc  murmur  can  be 
heard,  due  to  weakness  of  the  papillary  muscles.  Percussion  occa- 
sionally produces  pain  ;  at   an   advanced   stage    it    is  said   to  reveal 

K 


146  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

enlargement  of  the  precordial  area  of  dulness ;  but  these  are  theoreti- 
cal points  difficult  to  determine.  In  common  with  the  action  of  the 
heart  the  pulse  becomes  feeble,  irregular,  and  intermittent.  The 
functional  disturbance  produced  by  myocarditis  is  seldom  pronounced 
during  the  first  stage  of  the  disease  ;  and  as  the  condition  is  almost 
always  secondary,  this  functional  disturbance  cannot  be  differentiated 
from  that  due  to  the  infectious  disorder  of  which  the  heart  trouble  is 
only  a  complication.  But  the  symptoms,  especially  the  dyspnoea,  are 
always  aggravated  by  myocarditis. 

Contrary  to  what  one  might  imagine,  considering  the  extremely 
important  function  of  the  heart,  acute  myocarditis  terminates  in  a 
fairly  large  number  of  cases  in  recovery.  This  is  the  rule  in  the  slight 
forms  accompanying  infectious  conditions.  Resolution  slowly  pro- 
ceeds, the  heart  gradually  becomes  more  active,  and  its  contractions 
more  powerful,  until  at  length  the  sounds  resume  their  normal  charac- 
ter. Clinically  recovery  is  complete,  and  if  anatomically  it  remains 
imperfect  the  disease  leaves  few  traces.  In  a  proportion  of  cases  the 
inflammation  assumes  a  chronic  form. 

Death  may  occur  at  all  stages  ;  sometimes  suddenly  by  syncope, 
sometimes  less  rapidly  by  asphyxia.  When  by  asphyxia  dyspnoea 
increases,  the  face  appears  extremely  anxious,  the  apex  beat  of  the 
heart  becomes  imperceptible,  the  pulse  is  lost,  cold  sweats  cover 
the  body  ;  finally  the  patient,  completely  prostrated  and  unsteady  on 
its  legs,  falls  to  the  ground  and  dies  in  a  state  of  painful  collapse. 
During  convalescence  death  is  sometimes  produced  b}^  granular  or 
hyaline  degeneration  of  the  muscular  tissue.  If  in  purulent  myocar- 
ditis an  abscess  opens  through  the  endocardium,  death  results  from 
purulent  infection  or  cerebral  embolism.  Cases  of  this  kind  are  seen 
in  strangles.  When  myocarditis  accompanies  an  infectious  disease 
which  has  gravely  affected  the  lung,  kidney,  or  nervous  centres,  the 
lesions  in  these  organs  play  a  certain  part  in  producing  death. 

The  diagnosis  of  acute  myocarditis  is  difficult.  Many  infectious 
diseases  entail  disturbance  of  the  heart  simulating  myocarditis,  and 
in  addition  certain  of  the  local  symptoms  of  myocarditis  are  also 
common  to  pericarditis.  Nevertheless,  if  the  practitioner  follows  the 
development  of  the  latter  disease,  other  symptoms  will  be  detected 
which  forbid  confusion ;  and  when  pericardial  effusion  is  abundant, 
the  precordial  dulness  and  weakness  of  the  heart  sounds  are  much 
more  marked  than  in  myocarditis. 

Speaking  generally,  the  prognosis  is  grave.  Acute  m)'ocarditis  may 
lead  to  sudden  death  ;  in  point  of  fact  it  kills  many  animals  suffering 


MYOCARDITIS. 


147 


primarily  from  pneumonia.     You  have  also  seen  that  it  m.a}-  assume  a 
chronic  form,  and,  after  a  varying  period,  render  the  animal  useless. 

As  in  most  other  heart  diseases,  treatment  is  of  doubtful  efficacy. 
We  cannot  stop  the  processes  going  on  in  the  heart  muscle  by  admin- 
istering drugs.  Moreover,  the  practitioner's  attention  is  often  exclu- 
sively confined  to  the  primary  disease.  If  myocarditis  is  recognised  or 
suspected,  treatment  must  be  directed  towards  combating  the  ^\•cakness 
of  the  heart,  and  supporting  the  animal's  strength. 

The  food  should  be  fluid,  consisting  of  mashes,  gruel,  hav  tea,  or 
milk.  If  the  patient  will  eat  nothing,  beef  tea  ma}-  be  given  by  the 
rectum.  The  drugs  indicated  comprise  stimulants  like  alcohol,  wine, 
and  coffee  given  by  the  mouth  ;  caffeine,  str}-chnine,  and  ether  h\poder- 
mically ;  and,  if  myocarditis  is  secondary  to  pneumonia,  digitalis. 
Counter-irritation  by  means  of  a  mustard  plaster  applied  to  both 
sides  of  the  chest,  or  refrigeration  of  the  precordial  region,  may  also  be 
tried. 

In  contrast  with  the  acute  form,  chronic  myocarditis  often  occurs  as 
an  isolated  affection,  apart  from  any  other  existing  disease,  or  only 
associated  with  lesions  of  the  cardiac  serous  membranes  ;  and  inasmuch 
as  it  only  produces  vague  functional  disturbance,  and  very  imperfectly 
recognised  local  S3'mptoms,  it  often  escapes  notice  altogether.  No 
hesitation  is  felt  in  affirming  the  existence  of  cardiac  disease  when  a 
murmur  exists,  but  it  is  quite  otherwise  when  the  symptoms,  though 
apparently  due  to  heart  trouble,  are  unaccompanied  by  any  abnormal 
sound.  When,  however,  the  constitutional  symptoms  are  supple- 
mented by  modifications  in  the  action  of  the  heart — irregularities, 
momentary  arrests,  or  intermittencies — the  patient  in  the  majorit}^  of 
cases  is  suffering  from  a  condition  which,  though  insidious  and  of  slow 
progress,  is  nevertheless  extremely-  grave.  Most  frequenth'  these 
symptoms  are  due  to  chronic  inflammation  of  the  cardiac  muscle. 

As  a  general  rule,  chronic  myocarditis  follows  the  acute  form. 
Inflammation  of  the  myocardium  continues  in  a  less  degree,  slowly 
producing  degenerative  changes,  and  later,  functional  disturbance.  In 
certain  cases  this  inflammation  occurs  spontaneously  and  indirectly, 
in  consequence  of  cardiac  or  pulmonary  lesions,  which  produce  passive 
permanent  congestion  of  the  heart  muscle.  It  is  described  as  being 
produced  directly  by  excessive  functional  activity  of  the  heart,  i.  c.  by 
over-exertion.  Now  in  draught  animals,  and  especiall}-  in  horses, 
nothing  is  commoner  than  over-exertion,  but  the  usual  result  is  simply 
to  produce  hypertrophy  of  the  heart,  with  or  without  dilatation  of  its 
cavities.  Myocarditis  due  to  this  cause  alone  is  very  rare,  if  indeed  it 
ever  occurs.     The  cases  seen  are  usually  the  consequence  either  of  the 


148  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

acute  form  or  of  valvular  lesions  ;  or,  again,  of  some  obstacle  to  circula- 
tion reacting  on  the  cardiac  muscle,  and  forcing  it  to  work  more 
actively- — a  condition  which  first  produces  hypertroph}-,  and  sooner  or 
later  changes  of  the  nature  of  degenerative  myocarditis.  In  these 
cases  functional  hyperactivit}-  is  not  acting  alone,  but  is  supplemented 
by  permanent  passive  congestion  of  the  cardiac  muscle,  consequent  on 
the  impediment  to  circulation.  Under  this  double  influence,  changes 
occur  both  in  the  fibres  and  the  sarcolemma.  The  latter,  being  con- 
tinuously irritated,  responds  by  active  proliferation  (hyperplasia),  while 
the  muscular  fibres  undergo  granular  degeneration,  lose  their  striation 
and  contractility,  and  finally  disappear  under  the  pressure  of  the  new 
connective-tissue  growth.  Like  the  valvular  lesions  (of  which  it  is  a 
consequence)  this  myocarditis  is  oftenest  seen  in  the  left  heart.  The 
myocarditis  following  pulmonary  emphysema,  and  specially  marked  in 
the  right  heart,  is  due  to  a  similar  mechanism.  In  consequence  of 
stasis  and  increased  pressure  in  the  pulmonary  artery,  cardiac  circulation 
is  impeded ;  the  blood  escapes  with  difficulty  from  the  coronary  veins  ; 
the  cardiac  muscle  therefore  becomes  congested,  and  the  conditions 
for  degenerative  and  hyperplastic  changes  are  at  once  realised.  But,  I 
repeat,  diffuse  chronic  myocarditis  is  almost  always  a  deferred  con- 
sequence of  infectious  disease,  during  which  the  heart  has  been 
affected  ;  it  is  the  last  stage  of  inflammation  of  the  muscle  of  the  heart. 

Partial  or  superficial  myocarditis,  developed  by  contiguity  of  tissue, 
i.  e.  by  extension  to  the  cardiac  muscle  of  inflammation  at  first  localised 
in  the  pericardium  or  endocardium,  is  sometimes  seen.  Though  very 
rare  in  the  horse,  it  is  common  in  the  dog. 

In  exceptional  instances,  myocarditis  may  result  from  the  presence 
of  sclerostomata  (parasitic  worms)  in  one  of  the  coronary  arteries.  I 
reported  a  case  in  an  ass  suffering  from  chronic  myocarditis,  in  which 
the  left  coronary  artery  had  become  thrombosed,  and  close  to  its  origin 
showed  an  aneurism  containing  a  dozen  of  these  parasites. 

The  anatomical  changes  shown  by  the  cardiac  muscle  when  the  seat 
of  chronic  inflammation  result  from  two  constantl}-  associated  factors, 
the  effects  of  which,  however,  may  be  developed  to  any  degree,  and 
most  frequently  are  unequally  marked.  In  the  majority  of  cases  the 
dominant  lesion  is  the  proliferation  of  interstitial  connective  tissue 
leading  to  sclerosis  of  the  myocardium  ;  in  others  it  is  the  granulo-fatty 
degeneration  of  the  muscular  fibres. 

When  the  contractile  tissue  is  specially  affected,  the  heart  usually 
remains  of  normal  size,  being  simply  softer  and  more  relaxed,  though 
it  may  have  undergone  preliminar}-  hypertrophy.    After  recent  attacks, 


MYOCARDITIS.  I49 

sections  through  its  walls  appear  yellowish-red,  marked  with  patches 
or  stripes  of  a  lighter  colour.  Examined  microscopically,  the  fibres 
are  seen  to  have  lost  their  striation,  and  to  be  more  or  less  infiltrated 
with  proteid  granulations,  broken  up  and  partially  destroyed.  In 
addition,  there  is  often  a  slight  increase  in  quantity  of  connective  tissue. 

These  lesions  are  found  irregularly  distributed  in  both  hearts,  but 
especially  in  the  thickness  of  the  septum  and  of  the  wall  of  the  left 
ventricle.  They  may  be  little  marked  at  certain  points,  while  well 
developed,  or  even  of  old  standing,  in  others.  Cases  occur  where  the 
quantity  of  new  connective-tissue  growth  is  very  small,  and  where  the 
process  appears  to  consist  essentially  in  simple  granulo-fatty  degenera- 
tion of  the  muscular  fibres. 

In  fibrous  or  sclerosing  myocarditis,  by  far  the  most  common  form, 
the  heart  may  be  hypertrophied,  of  normal  volume,  or  more  or  less 
atrophied.  When  increased  in  size  the  hypertrophy  must  not  be 
ascribed  to  the  myocarditis  ;  it  has  preceded  the  latter,  having  resulted 
from  excessive  functional  activity  of  the  muscular  tissue,  necessitated 
by  the  presence  of  some  obstruction  to  the  free  circulation  of  blood. 
The  heart's  surface  is  marked  with  irregular  depressions,  corresponding 
to  portions  of  the  cardiac  muscle  which  have  undergone  fibrous  trans- 
formation, followed  by  contraction  of  the  new  connective  tissue.  The 
sclerosis  is  of  varying  depth  and  area.  In  a  general  sense  it  is  always 
of  vascular  origin,  resulting  primarily  from  proliferation  of  the  cells 
forming  the  walls  of  small  vessels,  and  gradually"  extending  to  the 
interfascicular  tissue,  producing  fibrous  new  growths,  which  afterwards 
compress  and  destroy  the  true  muscular  fibres.  This  cardiac  sclerosis 
is  sometimes  periarterial,  related  to  arterio-sclerosis,  sometimes  peri- 
venous, due  to  stasis  produced  in  the  last  period  of  valvular  disease, 
and  peculiar  to  what  M.  Huchard  has  called  in  man  "  cardiac  heart." 
Microscopic  examination  reveals  patches,  bands,  and  anastomosing 
networks  of  fibrous  tissue,  of  varying  size,  between  the  muscular  fibres, 
many  of  which,  in  consequence  of  their  pressure,  have  undergone 
degenerative  changes  or  have  altogether  disappeared. 

The  changes  due  to  myocarditis  when  accompanying  endocarditis 
or  pericarditis,  and  developed  by  contiguity  of  structure,  sometimes 
extend  to  the  entire  cortical  layer  of  the  muscle  ;  the  latter  showing  on 
section  a  zone,  several  millimetres  in  thickness,  of  a  reddish  pale  }ellow 
or  whitish  tint,  depending  on  the  stage  and  form  of  the  disease.  In 
this  layer  the  muscular  fibres  have  undergone  granulo-fatty  degenera- 
tion, or  have  become  atrophied  by  pressure  of  the  new  tissue  and 
fibrous  networks.  Instead  of  thus  being  spread  over  the  entire  surface 
of  the  myocardium,  the  lesions  are  in  many  cases  circumscribed.     In 


150  CLINICAL  vete:rinarv  medicine  and  surgery. 

valvular  endocarditis  they  are  almost  always  localised  near  the  auriculo- 
ventricular  or  arterial  openings.  The  process  extends  from  the  base  of 
the  valves  into  the  adjacent  zone  of  muscle,  and  thus  may  produce 
so-called  ''annular"  myocarditis.  Through  the  medium  of  the  cJwi'dcr 
tendinccc  it  may  extend  to  the  iiiuscuH  papillares,  and  end  by  transforming 
them  almost  entirely  into  iibrous  cords.  Similarly  in  pericarditis, 
secondary  localised  myocarditis  is  sometimes  seen  in  certain  parts  of 
the  superiicial  layers  of  the  muscle. 

Localised  myocarditis,  followed  either  by  fibrous  or  fatty  degenera- 
tion, may  weaken  the  ventricular  wall  until  it  yields  to  the  pressure  of 
blood,  and  finally  undergoes  saccular  dilatation,  producing  a  partial 
chronic  aneurism. 

Bearing  in  mind  the  functional  importance  of  the  heart,  and  the 
grave  nature  of  the  lesions  described,  it  might  be  expected  that 
chronic  myocarditis  would  produce  very  marked  symptoms  clearly 
indicating  its  existence.  On  the  contrar}^,  however,  the  disease  often 
continues  unperceived  for  months  or  even  years,  its  stages  succeeding 
one  another  very  slowly.  When  chronic  myocarditis  appears  as  a 
primary  condition,  animals  can  often  be  kept  at  their  usual  work  for 
a  long  time  ;  and  even  when  it  succeeds  to  the  acute  form,  they  are 
able  to  return  to  work  after  termination  of  the  latter. 

In  either  case  a  time  arrives  when  the  previously  latent  disease 
produces  disturbance  which  can  no  longer  be  ignored.  The  most 
ordinary  is  that  complex  condition  known  as  broken  wind,  especially 
marked  by  dyspnoea.  At  work,  difficulty  in  breathing  soon  occurs,  the 
heart's  action  becomes  strong  and  tumultuous,  and  true  palpitation  is 
perceptible  on  applying  the  hand  over  the  precordial  region.  In  some 
cases  the  horse  stops  suddenly  during  work,  and  is  often  thought  to 
be  suffering  from  colic,  but  in  animals  angina  pectoris,  like  vertigo, 
fainting,  and  syncope,  appears  to  be  rare.  During  this  preliminary 
period,  which  has  been  described  as  irritative,  palpitation  of  the  heart 
and  acceleration  of  the  pulse  can  be  detected,  even  when  at  rest  in  the 
stable. 

With  the  lapse  of  time,  dyspnoea  increases  during  work,  occurring 
in  paroxysms,  while  the  heart's  action  becomes  modified  and  the  pulse 
weak,  infrequent,  and  intermittent.  Not  only  does  palpitation  cease, 
but  the  contractions  of  the  heart  may  be  weaker  than  normal,  and, 
like  the  pulse,  infrequent,  irregular,  and  intermittent.  On  ausculta- 
tion, the  heart-sounds  are  rather  attenuated  in  granulo-fatt}'  myo- 
carditis, but  prolonged  and  accompanied  by  a  rolling  or  double  sound 
in  sclerosing  myocarditis,  with  hypertrophy  of  the  left  ventricle.     In 


MYOCARDITIS. 


151 


neither  of  these  forms  of  chronic  inflammation  of  the  myocardium  is 
there  a  murmur  unless  a  valvular  lesion  simultaneously  exists,  or 
unless  the  auriculo-ventricular  valves  are  imperfectly  controlled  in 
consequence  of  weakness  of  the  papillary  muscles.  In  some  cases 
percussion  reveals  enlargement  of  the  area  of  cardiac  dulness  due  to 
relaxation  of  the  walls  of  the  heart,  and,  in  granulo-fatty  myocarditis, 
to  dilatation  of  these  cavities,  in  fibrous  myocarditis  to  hypertrophy 
of  the  left  ventricle.  But,  as  in  the  acute  form,  this  symptom  is 
difficult  of  detection. 

If  the  animals  are  kept,  the  symptoms  become  continuously  aggra- 
vated, and  may  be  supplemented  by  respiratory  and  gastric  troubles 
of  reflex  character.  These  are  later  complicated  by  disturbance  due 
to  slowing  of  the  circulation  and  weakness  of  the  heart,  vascular  stasis, 
engorgement  of  the  lung  and  of  other  viscera,  dropsy,  oedema,  and 
finally  by  changes  which  indicate  exhaustion  of  the  heart.  Degenera- 
tive myocarditis  marks  the  last  phase  in  the  series  of  disorders  pro- 
duced by  valvular  lesions.  The  successive  changes  seen  during  the 
disease  originate  in  the  endocardium  ;  they  end  in  degeneration  of  the 
myocardium . 

Cortical  or  partial  myocarditis  produces  much  less  pronounced 
and  much  vaguer  symptoms.  In  the  horse  it  is  sometimes  only 
indicated  by  intermittency. 

Chronic  myocarditis  always  takes  a  very  slow  course  ;  it  continues 
for  years,  gradually  becoming  more  marked,  though  it  may  for  a  time 
remain  stationary.  It  never  tends  towards  recovery,  however.  If 
the  patients  are  kept,  death  follows  from  increasing  feebleness  and 
wasting,  or  unexpectedly  from  syncope  or  rupture  of  the  heart.  The 
ass  whose  case  I  described  was  found  dead  in  its  stall,  without  having 
stopped  work  a  single  day,  and  without  having  shown  any  serious 
respiratory  trouble,  despite  the  fact  that  in  its  case  myocarditis  was 
complicated  with  disease  and  insufficiency  of  the  aortic  valves. 
Rupture  of  the  heart  is  very  rare  in  all  animals,  though  it  may  occur 
under  the  influence  of  excessive  excitement,  or  of  a  fall,  or  violent 
effort  during  work.  The  heart  then  contracts  with  excessive  energy, 
the  intra-cardiac  pressure  suddenly  increases,  and  the  muscular  wall 
having  undergone  degenerative  change  yields  at  its  weakest  point — 
oftenest  in  one  of  the  ventricles,  at  the  seat  of  an  aneurism,  or  of  some 
fatty  or  fibrous  alteration. 

The  diagnosis  of  myocarditis  is  surrounded  with  many  difficulties. 
In  all  species  of  animals  mistakes  are  difficult  to  avoid,  and  diagnosis 
should  be  delivered  with  great  circumspection.      The  disease  is  sug- 


152  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

gested  by  the  history,  by  the  visible  symptoms,  and  especially  by  the 
attacks  of  dyspnoea  which  affect  most  patients  during  work.  The 
cardiac  symptoms  must  be  viewed  as  a  whole,  particular  attention 
being  given  to  those  detected  on  auscultation,  and  examination  of  the 
pulse  ;  while  other  diseases  capable  of  producing  the  functional  dis- 
turbances noted  must  be  disposed  of  by  a  process  of  exclusion. 

The  prognosis  is  very  grave.  If  the  disease  is  not  immediately 
threatening  it  always  ends  by  disabling  its  subjects,  and  sooner  or 
later  entails  death. 

The  only  useful  treatment  consists  in  endeavouring  to  control 
inflammation  of  the  cardiac  muscle  by  the  administration  of  salts  of 
iodine,  and  in  stimulating  those  cardiac  fibres  which  have  escaped 
destruction.  For  this  purpose  heart  stimulants  and  tonics  like  nux 
vomica  and  its  derivatives,  or  caffeine,  may  be  given  ;  where,  however, 
symptoms  of  broken  wind  exist  and  the  myocarditis  is  little  pro- 
nounced, arsenic  and  sometimes  digitalis  give  better  results. 


XXIIL— OSSIFICATION    OF   THE    CARDIAC    AURICLES. 

This  morning    I    purpose    speaking  of   ossification    of    the    righ 
auricle,  a  lesion  which  is  sometimes  seen  in  the  horse,  and  though  not 
mentioned   in  the   majority  of  classic  works,   has  occasionally  been 
reported  in  French  and  other  periodical  publications. 

I  will  give  you  the  details  of  a  case.  This  specimen  which  I 
exhibit  was  obtained  by  M.  Barillot,  a  veterinary  surgeon  practising 
in  Paris,  at  the  post-mortem  examination  of  a  pony.  It  is  a  greatly 
enlarged  and  almost  completely  ossified  right  auricle  ;  its  anterior 
portion  is  thickened  and  of  bony  consistence  throughout,  but  the 
upper  part  has  only  undergone  this  change  to  a  limited  extent.  It 
presents  rounded  irregular  areas  of  spongy  bone  tissue,  varying  in  size 
between  that  of  a  large  pea  and  of  a  sixpence ;  almost  all  project 
more  or  less  on  both  surfaces  of  the  auricle. 

In  the  Coinpte  Rendu  des  Travaux  de  rEcole  d'Alfort  for  the  session 
1836-7,  Renault  mentioned  in  the  following  terms  a  case  of  the  same 
nature  seen  in  a  glandered  horse,  whose  age,  however,  is  not  given. 
"  The  right  auricle  was  considerably  enlarged  and  weighed  2  lbs.,  was 
thickened  and  ossified  throughout  nine  tenths  of  its  extent,  and  the 
muscular  fibres  had  been  compressed  and  atrophied  by  the  bony  new 
growth.  The  lesions  on  the  convex  surface  of  the  auricle  were  as 
hard  and  resonant  as  bone.  They  were  less  developed  in  the  interior, 
where  they  had  the  appearance  and  consistence  of  cartilage.  Ossifica- 
tion suddenly  ceased  at  the  junction  of  the  auricle  with  the  ventricle, 
and  at  the  upper  part  where  the  auricle  becomes  continuous  with 
the  venae  cavse.  At  their  junction  the  veins  formed  an  accidental 
pouch  with  muscular  walls,  the  substance  of  which  was  continuous 
with  that  of  the  auricle,  and  appeared  to  have  assisted  the  latter  in  its 
function.  The  other  portions  of  the  heart  were  healthy."  Renault 
adds  that  cases  of  partial  ossification  of  the  heart,  and  especially  of 
the  auricles,  had  previously  been  noted  in  men  and  animals. 


154  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

In  1840  Bouley  the  younger,  acting  on  behalf  of  Barthelemy,  vete- 
rinary surgeon  at  Paris,  communicated  to  the  Academic  de  Medecine  a 
case  of  hypertrophy  of  the  heart,  with  complete  ossification  of  the 
right  auricle,  in  a  six-year-old  horse.  The  animal  had  been  bought 
five  months  before,  and  was  unable  to  do  regular  work.  It  did  not 
cough,  but  rapidly  lost  breath  after  the  least  work;  the  respiration, 
while  remaining  regular,  was  sometimes  extremely  rapid,  and  suggested 
dyspnoea.  As  it  was  thought  that  improvement  would  follow  a  rest  at 
grass,  the  animal  was  sent  to  a  farm  in  the  neighbourhood,  where  it 
remained  for  two  months.  On  returning  it  was  put  to  work,  but 
found  to  be  in  nowise  improved,  and  some  time  later  died  from  pneu- 
monia. The  post-mortem  examination  revealed,  in  addition  to  recent 
and  old-standing  pulmonary  lesions,  hypertrophy  of  the  heart  and 
ossification  of  the  right  auricle,  which  was  fixed  to  the  pericardium  by 
fibrous  bands.  The  capacity  of  the  auricle  was -at  least  doubled,  and 
its  walls,  thickened  to  the  extent  of  one  inch  and  a  quarter  to  one  inch 
and  a  half,  were  completely  ossified. 

In  this  communication  Bouley  refers  to  Renault's  case,  mentions  a 
case  of  complete  ossification  of  one  auricle  seen  by  Barthelemy  the 
elder,  in  a  cow  affected  with  pulmonary  tuberculosis  ;  and  another, 
mentioned  by  Riquet,  of  partial  ossification  of  one  of  the  ventricles  in 
a  horse.  He  regards  ossification  of  the  auricles  as  extremely  rare, 
inasmuch  as  Girard  and  Rigot  do  not  appear  to  have  seen  a  single  case 
in  the  animals  destroyed  at  Alfort  for  practical  surgical  operations  and 
anatomical  purposes  during  a  period  of  nearly  forty  years. 

In  Godwing's  case  the  horse's  age  is  not  mentioned,  though  we  are 
told  that  it  several  times  showed  serious  symptoms,  which  were  referred 
to  "disease  of  the  liver,  complicated  by  interference  with  circulation." 
It  was  finally  slaughtered.  The  post-mortem  examination  showed  the 
existence  of  fibrous  pericarditis.  The  auricle  was  cartilaginous  through- 
out most  of  its  upper  part,  and  its  anterior  sections  were  ossified. 

Among  the  many  horses  examined  after  death  at  Alfort  between 
1848  and  1863,  Colin  twice  found  the  right  auricle  completely  ossified, 
and  twice  saw  tracts  of  bony  tissue  of  varying  size. 

The  horse,  whose  case  was  reported  in  1884  by  Chouchou  to  the 
Societe  Centrale  de  Medecine  Veterinaire,  was  eight  years  old.  For 
three  years  it  had  belonged  to  a  firm  of  carriers,  and  had  always  worked 
well,  showing  no  sign  of  disease.  One  day,  without  apparent  cause, 
it  appeared  depressed,  and  had  to  be  rested  for  a  week.  For  a  time  it 
seemed  to  recover,  but  soon  returned  to  hospital  with  oedematous 
swellings  in  different  regions  and  marked  enlargement  of  the  hind 
limbs,   symptoms  at  first   regarded  as  due  to  purpura  hsemorrhagica 


OSSIFICATION    OF    THE    CARDIAC    AURICLES.  155 

and  afterwards  to  glanders.  Soon  afterwards  a  sarcocele  developed 
and  was  operated  on.  With  a  little  pus  taken  from  the  end  of  the 
epididymis  a  guinea-pig  was  inoculated.  The  result  was  negative. 
The  patient  steadily  became  weaker,  and  was  finally  slaughtered.  On 
incising  the  pericardium  lesions  of  fibrinous  pericarditis  were  found. 
The  heart  was  verj-  large,  the  ventricles  dilated  and  their  walls  thinned. 
The  right  auricle  was  whitish  and  hard,  its  cavity  diminished  in  size, 
and  its  walls  ossified  throughout  almost  their  entire  extent.  It  weighed 
nearly  four  pounds. 

Veret's  case  was  that  of  a  seventeen-3'ear-old  trooper  which  died  in 
consequence  of  a  fracture.  On  post-mortem  the  right  heart  was  found 
to  be  "  calcified." 

I  pass  over  in  silence  some  other  cases  reported  abroad.  They  add 
nothing  interesting  to  what  I  have  just  related. 

Let  us  now  return  to  the  horse,  in  which  M.  Barillot  found  the 
specimen  he  has  sent  us.  Its  history  can  be  given  in  a  few  words :  — A 
pony  bought  in  London,  in  October,  1895,  attacked  with  some  chest 
disease  soon  after  its  arrival  in  Paris.  Became  convalescent  in  a 
fortnight,  and  was  sent  to  grass  in  the  He  Saint-Denis,  for  three  weeks'. 

Before  its  illness  this  pony  was  very  lively,  and  had  good  action, 
for  which  reason  it  cost  a  considerable  sum.  On  being  returned  to  its 
owner  it  had  lost  its  vigour  and  pace,  was  "  soft  "in  work,  dull  in  the 
stable,  hung  back  from  the  manger,  and  its  extremities  were  cold.  On 
the  5th  January  an  oedematous  swelling  appeared  under  the  chest. 
My  colleague,  who  was  at  once  called,  carefully  examined  the  animal, 
and  diagnosed  pleurisy,  at  the  same  time  noting  certain  signs  of  heart 
disease.  Treatment  pro\ed  unsuccessful,  and  two  days  later  the  pony 
died. 

On  post-mortem  the  pleural  cavity  was  found  to  contain  an  abundant 
exudate ;  the  heart  was  hypertrophied  ;  and  the  walls  of  the  right 
auricle  were  thickened,  hard,  and  ossified  throughout  the  greater 
portion  of  their  surface.  The  case,  therefore,  was  one  of  ossification  of 
the  heart  muscle.  Sections  showed  the  characteristic  appearances  of 
bony  tissue,  concentric  bony  lamellae,  and  osteoplasts. 

Ossification  of  the  auricles  is  most  common  in  aged  animals,  though 
sometimes  seen  in  relatively  young  subjects.  The  pony  of  which  I 
have  just  spoken  was  only  five  years  old.  A  further  curious  point  is 
that  the  right  auricle  is  almost  always  the  sole  point  attacked ;  even 
when  it  is  completely  ossified  the  left  auricle  is  usuall}-  entirel}'  free. 

The  causes  of  this  peculiar  change  in  the  heart  are  unknown.     In 


156  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

most  reported  cases  heart  lesions  have  either  been  compHcated  by 
others  Hke  pericarditis,  or  by  emphysema,  glanders,  or  tuberculosis  ; 
while  the  cavity  of  the  right  auricle  has  been  found  greatly  enlarged, 
owing  without  doubt  to  insufficiency  of  the  tricuspid  valve. 

When  limited  to  one  part  of  the  auricle  and  only  affecting  the  roof 
or  cul-de-sac,  for  example,  ossification  produces  no  appreciable  sym- 
ptoms, and  is  always  a  surprise  on  post-mortem ;  but  when  extended  to 
the  greater  part,  or  to  the  entire  auricle,  particularly  if  the  latter  be 
dilated,  and  the  auriculo-ventricular  opening  more  or  less  enlarged — 
troubles  occur  which  clearly  suggest  the  existence  of  heart  disease. 
They  include  dyspnoea,  palpitation,  venous  pulse,  and  at  a  later  stage 
swellings  about  the  thorax  and  extremities.  Even  in  presence  of  these 
complications,  however,  exact  diagnosis  is  impossible.  The  most  one 
can  discover  is  that  the  disease  is  located  in  the  heart. 

The  various  drugs  which  have  been  used  all  appear  equally  useless. 
In  point  of  fact  no  treatment  is  efficacious. 


XXIV.— CARDIAC  INTERMITTENCY  IN  THE  HORSE. 

For  ten  days  past  we  have  had  in  stable  No.  6  a  horse  recovering 
from  pneumonia,  in  which  the  day  after  entry  we  discovered  by 
auscultation  true  cardiac  intermittency,  certainly  of  older  standing 
than  the  pulmonary  disease.  I  called  your  attention  to  this  patient, 
and  to  the  character  of  the  intermittency.  Allow  me  to-day  to  return 
to  this  variety  of  cardiac  disturbance,  which  is  common  in  the  horse, 
but  concerning  which  )ou  will  find  very  little  in  text-books  and 
periodicals. 

In  a  normal  state,  and  under  normal  conditions,  the  heart  beats 
with  perfect  regularity.  In  an  animal  of  any  given  species  it  contracts 
the  same  number  of  times  within  the  same  period,  though  its  sounds 
are  not  invariably  of  one  character.  In  the  horse  especially  it  is  not 
uncommon  to  find  modifications  in  their  intensity  and  tone,  and  a 
tendency  to  doubling  of  one  or  other.  To  convince  yourselves  of 
this,  you  have  onl}^  to  auscultate  a  number  of  the  patients  now  under 
treatment. 

The  action  of  the  heart  is  subject  to  an  entire  series  of  disturbances, 
some  common  and  ephemeral,  others  produced  by  change  in  the  organ 
itself,  or  in  the  nerves  supplying  it.  The  number  of  contractions  may 
be  modified,  increased,  or  diminished  by  many  pathological  states. 
Sometimes  the  rhythm  is  slowed,  a  condition  known  as  bradycardia  ; 
more  frequently  accelerated,  tachycardia.  Either  of  the  two  sounds 
noted  during  each  heart  cycle  may  be  doubled  or  replaced  by  a  murmur. 
The  cardiac  systole  and  the  pulsations  of  the  arteries  may  be  of  unequal 
force.  In  all  these  cases  the  regularity  of  rhythm  of  the  heart  and  of 
the  pulse  are  generall}-  preserved,  the  pulsations  succeeding  one  another 
at  equal  intervals. 

But  in  some  animals  the  cardiac  systole  and  the  arterial  pulsations, 
whether  equal  or  unequal  in  force,  no  longer  succeed  one  another 
regularly.  At  more  or  less  frequent  intervals  the  heart's  activity  is 
completely  suspended  for  a  short  period,  or  the  contractions  are  feeble, 


158  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

and  in  both  cases  one  or  more  arterial  pulsations  may  be  absent. 
These  troubles  characterise  both  varieties  of  cardiac  intermittency  seen 
in  man  by  Laennec.  In  true  intermittency  it  seems  as  though  the 
heart  were  really  arrested  for  the  moment,  its  contractions  completely 
ceasing.  In  false  intermittency  a  certain  number  of  cardiac  cycles, 
normal  as  regards  strength,  are  followed  by  a  feeble  abortive  contrac- 
tion, which  has  no  effect  on  the  arteries,  and  which  does  not,  therefore, 
cause  their  walls  to  rise  ;  only  the  pulse  is  then  really  intermittent. 
In  both  these  varieties  of  intermittency,  therefore,  the  regular  cardiac 
or  arterial  pulsation  is  merely  interrupted,  whilst  in  true  irregularity 
(arythmia)  the  pulsations  are  irregular  or  unequal,  and  the  period  of 
the  cardiac  cycle  is  prolonged  or  shortened  ;  in  intermittency  the  heart 
usually  beats  normally  save  during  the  period  of  arrest.  Both  these 
conditions  may  be  found  associated. 

I  merely  mention  the  false  intermittencies  usually  seen  during 
diseases  of  the  heart  and  of  some  other  viscera.  In  patients  showing 
this  condition  the  pulse  is  not  only  intermittent,  but  irregular,  unequal, 
and  frequently  almost  imperceptible. 

In  patients  with  true  intermittency,  auscultation  of  the  heart  reveals 
a  regular  succession  of  orderly  and  equal  beats,  followed  by  a  long 
silence,  coinciding  with  an  abnormal  prolonged  rest  of  the  heart,  then 
a  new  series  of  normal  pulsations,  to  which  succeeds  a  further  silence, 
and  so  on.  Apart  from  these  suspensions,  which  from  time  to  time 
and  more  or  less  periodically  break  the  series,  the  heart  acts  regularly. 
The  frequence  of  the  arrests  varies  greatly.  Sometimes  they  are 
separated  by  unequal  periods  of  time,  and  are  repeated  every  second, 
third,  tenth,  twelfth,  or  fifteenth  pulsation  ;  sometimes  they  succeed  at 
equal  intervals,  /.  e.  after  the  same  number  of  pulsations,  usually  from 
two  to  six.  One  sees  horses  in  which  the  pauses  are  rhythmical  to  a 
very  remarkable  degree  ;  in  others  the  periodicity  is  subject  to  variation. 
During  the  course  of  the  day  the  same  animal  may  at  certain  times 
show  regular,  and  at  others  irregular  intermittency.  In  some  rare 
cases  the  series  of  pulsations  are  separated  by  long  intermittencies, 
which  again  are  interrupted  by  a  false  beat. 

The  duration  of  the  arrests  is  generally  in  inverse  proportion  to  the 
number  of  pulsations  in  the  series.  It  usually  corresponds  to  one  or 
two  cardiac  cycles,  though  occasionally  shorter  or  longer.  In  a  case 
mentioned  by  Siedamgrotzky  the  heart  beat  sixteen  to  twenty  times 
per  minute,  the  beats  occurring  singly  or  in  groups  of  two,  three,  or  four, 
separated  by  arrests  corresponding  in  duration  to  two,  three,  or  four 
pulsations.     At    the  post-mortem   of  this    horse   the    heart  was  found 


CARDIAC    INTERMITTENCY    IN    THE    HORSE.  1 59 

hypertrophied,  and  its  muscular  substance  degenerated.  Some  months 
ago  in  the  outer  clinique  we  saw  a  horse  in  which  the  beats  occurred 
in  groups  of  three,  four,  or  five,  separated  by  pauses  equal  in  length  to 
two  cardiac  cycles. 

Whatever  the  duration  of  the  series  of  beats  or  pauses,  the  first 
contraction  after  the  intermittency  is  almost  always  stronger  than  the 
others.  Sometimes,  and  particularly  when  the  animal  has  just  been 
exercised,  it  is  violent,  recalling  palpitation,  while  the  second  contrac- 
tion always  follows  rapidl}'  and  at  a  shorter  interval  than  the  others. 

In  some  instances  the  usual  cardiac  stimuli  fail  to  act,  or  have  little 
effect  on  the  intermittency.  If,  in  order  to  accelerate  the  beating  of 
the  heart,  the  patient  is  trotted  for  a  few  moments,  they  may  continue 
as  before  ;  but  in  general  the  intermittencies  noted  during  rest 
diminish  in  frequency,  or  temporarily  disappear  under  the  influence  of 
exercise.  Last  month  I  examined  a  patient  showing  this  peculiarity. 
The  horse  was  five  years  old,  had  been  bought  six  months  before,  and 
was  at  first  a  good  worker.  Two  months  before  being  brought  here  it 
began  to  lose  its  hard  condition,  showed  difficulty  in  breathing,  and  was 
ufifit  for  even  moderate  work,  though  it  still  appeared  well-nourished. 
On  watching  the  flank,  expiration  was  seen  to  be  double.  On  ausculta- 
tion every  fourth  or  fifth  heart-beat  was  found  to  be  followed  by  an 
intermittency  equal  in  length  to  one  or  two  pulsations.  Both  cardiac 
sounds  were  abnormal,  the  first  being  prolonged  and  the  second 
double.  After  a  few  minutes'  exercise  the  intermittency  disappeared, 
the  beats  succeeding  at  regular  inter\-als  ;  but  after  a  further  few  minutes 
the  arrests  recurred  at  first  at  rare  intervals,  then  more  and  more 
frequently. 

During  the  last  few  years  I  have  noted  true  intermittency,  certainly 
of  old  standing,  in  several  horses  undergoing  treatment  in  hospital  for 
external  diseases,  but  which  had  never  shown  symptoms  of  heart 
disease.     I  will  describe  two  cases. 

In  1895  we  had  in  the  infirmary  a  horse  sufl'ering  from  picked-up 
nail,  which  showed  intermittency  of  the  pulse  and  arrest  of  the  heart ; 
neither  condition,  I  need  scarcely  say,  had  any  causal  connection  with 
the  injury.  The  heart-beats  occurred  in  series  of  three  to  six,  sepa- 
rated by  silent  periods  of  uniform  length,  lasting  as  long  as  one  pulsation. 
The  first  systole  of  each  series  was  sudden,  bounding,  and  immediately 
followed  by  a  second  much  weaker  contraction,  then  by  others  of 
diminishing  strength.  The  \iolent  struggles  during  operation,  and 
the  traumatic  fever  which  followed  it,  had  no  effect  on  the  intermit- 
tency. The  animal  left  here  in  the  same  condition  as  when  it  entered  ; 
the  periodicity  and  duration  of  the  arrests  were  precisely  the  same. 


l6o  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

Previous  to  the  accident  for  which  the  horse  was  sent  here  no  dis- 
turbance or  symptom  suggesting  cardiac  irregularity  had  been  remarked. 
According  to  its  driver's  account  the  horse  even  seemed  brighter  and 
more  spirited  than  the  animals  with  which  it  worked. 

In  1894  we  discovered  similar  disturbance  in  a  ten-year-old 
carriage  horse,  sent  here  from  the  department  of  the  Maine-et-Loire 
on  account  of  spavin  lameness.  This  horse  was  very  fast  and  powerful, 
and  had  never  shown  symptoms  of  heart  disease.  The  pupil  who 
attended  it  was  instructed  to  keep  me  informed  of  the  changes  in  the 
pulse  and  heart.  The  intermittency  lasted  as  long  as  two  complete 
heart  cycles,  and  occurred  after  every  three  or  six  pulsations,  long  and 
short  series  succeeding  one  another  in  an  extremely  irregular  fashion. 

The  aetiology  of  cardiac  intermittency  is  complex,  and  its  pathology 
even  more  obscure.  In  certain  cases  where  it  has  been  observed  apart 
from  any  manifest  organic  change  it  has  been  attributed  to  overw^ork 
or  digestive  trouble ;  but,  except  when  produced  by  excessive  doses  of 
digitalis,  it  usually  indicates  some  heart  disturbance. 

Of  the  organic  lesions  it  most  frequently  accompanies  myocarditis, 
at  times  endocarditis  and  pericarditis.  Its  final  cause  always  appears 
to  be  either  primary  or  secondary  disease  of  the  cardiac  muscle,  or 
some  disturbance  of  the  nervous  apparatus  of  the  heart.  On  account 
of  intermittency  being  usually  due  to  myocarditis,  it  is  often  accom- 
panied by  other  symptoms  like  dulness,  rolling,  and  doubling  of  the 
heart-sounds,  which  indicate  or  at  least  suggest  disease  of  the  heart 
muscle. 

Temporary  intermittency,  true  or  false,  regular  or  irregular,  often 
appears  during  various  specific  diseases  in  consequence  of  the  heart 
being  attacked  by  infectious  organisms  or  their  toxins.  I  have  often 
observed  intermittency  during  pneumonia,  and  those  practitioners  who 
auscultate  the  heart  during  such  attacks  have  certainly  had  similar 
experience.  In  the  Bulletin  de  la  Societc  Ccntrale  dc  Medecine  Vete- 
rinaire  for  1894  I  described  a  case.  I  may  here  mention  a  more 
recent  instance. 

At  the  commencement  of  last  December  I  received  into  hospital  a 
six-year-old  horse  with  acute  pneumonia  of  three  days'  standing.  The 
disease  was  of  moderate  gravity,  rather  benign  in  character ;  the  tem- 
perature did  not  exceed  40*5  °  C.  (i04'9°  F.),  and  the  fever  declined  on 
the  sixth  day.  Every  morning  after  having  examined  the  state  of  the 
lung  I  auscultated  the  heart.  During  resolution,  the  tenth  day  of  the 
attack,  I  noted  intermittency  ;  a  pause,  equal  in  length  to  that  of  one 
cardiac  cycle,  following  series   of  six   to  ten  contractions,  normal   in 


CARDIAC    INTKRMITTENCV    IN    THE    HORSE.  l6l 

respect  of  strength  and  rh}'thm.  During  the  following  dajs  these 
intermittencies  became  more  frequent,  one  occurring  after  each  fourth 
or  fifth  pulsation.  At  the  end  of  a  week  they  could  onl}'  be  noted  after 
a  regular  series  of  eight  to  ten  pulsations.  They  did  not  change  before 
the  animal  left  the  hospital  ;  I  ma}-  add  that  digitalis  had  not  been 
given. 

Usually  ephemeral  in  character,  but  sometimes  obstinate  or  even 
permanent,  such  intermittency  is  commonest  in  cases  of  pneumonia 
which  at  the  onset  have  shown  other  cardiac  disturbance  like  marked 
acceleration  and  violent  action  of  the  heart,  or  modification  in  the 
sounds. 

The  seriousness  of  intermittenc}-  depends  on  man}-  conditions,  but 
especially  on  its  frequency,  duration,  and  the  presence  or  absence  of 
other  cardiac  troubles.  When  recent,  and  occurring  during  the  course 
of  or  during  convalescence  from  acute  diseases,  it  generally  disappears 
rapidly,  and  does  not  return.  \\^hen  of  old  standing  (whatever  the 
primar}-  disease  to  which  it  is  due)  it  commonly  indicates  change  in 
the  heart  muscle,  or  in  its  nervous  supply,  and  caution  must  be 
observed  in  delivering  an  opinion.  Though  not  necessarily  implying 
the  existence  of  any  organic  disease,  or  material  change  in  the  heart, 
yet  in  the  great  majorit}-  of  cases  it  follows  injur}-  to  the  heart  muscle 
or  its  nervous  supply.  Certain  horses  still  continue  useful  for  years, 
but  are  none  the  less  affected  in  one  of  their  most  important  organs. 

The  treatment  resembles  that  of  myocarditis,  the  principal  agents 
being  the  iodide  of  potassium  or  sodium  and  digitalis.  In  old-stand- 
ing intermittency  drugs  have  little  effect  ;  they  are  onl}-  useful  within  a 
comparative!}-  short  time  after  the  onset  of  disease. 

In  a  patient  which  had  suffered  from  strangles,  and  in  which  inter- 
mittency followed  every  three  or  four  pulsations,  I  prescribed  a  zi- 
drachm  dose  of  iodide  of  potassium  dail}-,  afterwards  increasing  it  to 
3J  drachms.  This  treatment  was  only  commenced  three  months  after 
recovery  from  strangles,  and  was  continued  for  six  weeks,  with  two 
interruptions  of  a  week,  the  animal  being  meanwhile  kept  at  quiet 
work.  At  the  end  of  two  months  the  intermittency  still  continued,  but 
at  longer  intervals,  being  separated  by  series  of  six,  eight,  or  ten  pulsa- 
tions.    It  afterwards  became  less  frequent  and  finally  disappeared. 


XXV.— PERICARDITIS    IN    THE    DOG. 

During  the  past  few  months  we  have  seen  a  considerable  number 
of  cases  of  peritoneal  dropsy  in  the  dog,  and  I  have  shown  you  that  in 
these  animals  ascites  is  very  often  associated  with  tuberculosis,  peri- 
carditis, or  valvular  endocarditis.  This  fact  must  always  be  borne  in 
mind  when  giving  an  opinion  and  directing  treatment.  You  will 
therefore  understand  why,  when  called  on  to  treat  dogs  with  abdominal 
■dropsy,  I  do  not  confine  myself,  as  was  usually  so  long  and  is  still  the 
•custom,  to  evacuating  the  liquid  collected  in  the  peritoneum  and  pre- 
scribing wine  of  squills  or  similar  remedy  ;  but  always  examine  the 
heart  by  palpation,  percussion,  and  auscultation,  and  submit  the 
patient  to  the  tuberculin  test. 

In  order  to  estimate  the  gravity  of  the  condition,  and  decide  whether 
the  patient  is  or  is  not  amenable  to  treatment,  it  is  not  sufficient  merely 
to  show  that  the  ascites  depends  on  pericarditis,  for,  as  I  have  already 
shown  during  a  previous  lecture,  pericarditis  in  the  dog  is  often  of 
tuberculous  character.  When,  therefore,  dogs  with  pericardial  effusion 
■distinctly  react  to  tuberculin,  the  pericardial  disease  is  probably  tuber- 
culous ;  and  although  failure  to  react  does  not  entirely  eliminate  the 
•question  of  tuberculosis,  it  at  least  greatly  strengthens  our  belief  that  a 
cure  maybe  effected.  It  is  this  latter  point  which  I  wish  to  emphasise 
to-day.  I  shall  first  describe  a  case  affected  with  pericarditis  and  ascites, 
which  was  cured  by  puncturing  the  abdomen  and  pericardium. 

Towards  the  middle  of  last  April  a  three-year-old  sheep-dog,  which 
had  always  enjoyed  good  health,  was  brought  to  hospital  on  account  of 
disease  of  a  fortnight's  standing.  Without  doubt  it  had  suffered  from 
distemper,  but  of  so  trifling  a  character  as  to  have  escaped  observation. 
At  the  beginning  of  April  the  dog  lost  its  spirits ;  its  appetite  became 
capricious,  and  was  afterwards  lost ;  the  abdomen  increased  in  size ; 
walking  was  painful,  and  soon  caused  loss  of  breath. 

When  submitted  to  our  notice  this  patient  showed  all  the  external 
signs  of  some  grave  visceral  disease.     Apart  from  the  emaciation  and 


PERICARDITIS    IN    THE    DOG.  163 

weakness,  three  points  immediately  attracted  attention — the  rapid 
breathing,  size  of  the  abdomen,  and  presence  of  a  swelHng  under  the 
chest.  The  abdomen  was  largest  about  its  lower  part,  which  was  dull 
when  percussed  and  showed  fluctuation,  pointing  to  the  presence  of 
ascitic  exudate.  The  respiration  was  rapid,  short  and  sighing,  numbered 
thirty-five  to  forty  per  minute,  and  movement  and  exertion  of  any  kind 
like  walking  caused  oppression.  On  auscultating  the  chest  the  vesi- 
cular murmur  was  only  heard  distinctly  in  the  upper  half  of  either  lung. 
The  heart-beats  were  difficult  to  feel,  and  the  normal  heart-sounds 
were  obscure,  distant,  and  smothered.  The  pulse  at  the  femoral  artery 
was  very  feeble,  and  about  130  per  minute.  The  jugulars  showed 
very  clearly  marked  venous  pulse.  The  temperature  was  39*2^  C. 
<i02-5°  F.). 

On  the  same  day  we  tapped  the  abdomen,  and  withdrew  about  two 
quarts  of  a  slightly  red  serous  liquid.  During  the  evening  and  the 
next  day  the  animal  was  spoon-fed  with  milk,  and  15  eg.  (2"25  grains) 
of  calomel  were  given.     Tuberculin  produced  no  reaction. 

On  the  following  day,  although  fever  was  slight  (the  temperature 
not  exceeding  38'9^  C.  =  102°  F.),  the  condition  had  become  more 
alarming.  The  abdomen,  reduced  after  tapping,  had  again  increased, 
and  the  swelling  under  the  chest  was  somewhat  larger.  The  impulse 
and  beating  of  the  heart  were  imperceptible  ;  the  arterial  pulse  was  still 
feebler  than  on  the  previous  day,  but  the  venous  pulse  more  marked. 
The  respirations  were  forty-five  per  minute ;  the  depression  appeared 
greater,  and  death  imminent.  After  morning  hospital  inspection  I 
punctured  the  pericardium  with  an  aspirator  and  fine  needle  opposite 
the  fifth  intra-costal  space,  about  two  and  a  quarter  inches  above  the 
line  of  the  sternum,  withdrawing  nearly  six  and  a  half  ounces  of  slightly 
red-stained  liquid  similar  to  that  obtained  from  the  abdomen  on  the 
previous  day. 

Immediate  improvement  followed.  The  patient's  face  lost  its 
anxious  expression,  the  dyspnoea  diminished,  and  the  respiration 
became  easier.  During  the  evening  and  night  the  animal  several 
times  took  milk. 

Next  day  the  improvement  continued.  The  morning  temperature 
was  38"6°  (ioi'4°  F.),  the  respiration  27,  and  the  pulse  112.  The 
heart-beats  could  be  felt,  both  normal  sounds  were  heard,  and  the 
venous  pulse  disappeared.  I  prescribed  infrictions  of  antimonial  oint- 
ment over  the  precordial  region.      Milk  feeding  was  continued. 

Within  a  few  days  disturbance  rapidly  diminished.  At  the  end  of 
a  week  the  appetite  and  general  spirits  returned.  Fed  on  meat,  rice, 
and   milk,  the  convalescent   rapidly  regained   strength  and   condition. 


164  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

When  returned  to  its  owner  a  fortnight  after  the  second  operation  it 
was  almost  completel}-  cured. 

When,  however,  pericarditis  in  the  dog  results  from  tuberculosis, 
or  has  given  rise  to  local  or  visceral  lesions  of  a  more  or  less  per- 
manent character,  the  results  of  tapping  the  pericardium  are  seldom  as 
successful  as  in  the  above  case.  But  in  certain  forms  of  pericarditis 
which  develop  slowly,  rapid  cure  is  possible  even  when  the  condition 
has  existed  for  a  comparativel}-  long  time.  The  following  case  bears 
witness  to  this. 

During  August,  i8g6,  a  four-year-old  setter,  which  had  been  ill  for 
nearly  six  weeks,  was  brought  for  examination.  Though  usually  very 
bright  and  affectionate,  this  dog  had  become  dull,  had  kept  out  of  sight 
and  remained  continually  lying  down,  while  it  scarcely  touched  food. 
On  the  few  occasions  when  it  accompanied  its  master,  walking 
was  followed  by  loss  of  breath,  which  forced  it  to  stop,  gasping  for 
breath. 

When  brought  here  its  emaciated  state  and  enlarged  abdomen  at 
once  arrested  attention.  Palpation  of  the  abdomen  revealed  the 
presence  of  a  large  quantity  of  ascitic  exudate.  The  respiration  was 
rapid  and  painful,  inspiration  being  slow  and  prolonged,  expiration 
rapid.  On  auscultation  the  vesicular  murmur  was  almost  normal  in 
the  upper  parts  of  both  pulmonary  lobes,  but  absent  in  the  lower.  On 
applying  the  hand  to  the  left  thoracic  wall,  over  the  cardiac  region  the 
iieart's  impulse  could  not  be  felt,  and  on  auscultation  both  normal 
sounds  were  very  feeble  and  difficult  to  detect.  Percussion  showed  the 
zone  of  cardiac  dulness  to  be  much  more  extensi\-e  in  front,  towards  the 
back,  and  in  an  upward  direction  than  normal.  The  limits  of  this  dull 
zone  were  practically  the  same  whether  percussion  were  performed  with 
the  animal  in  the  ordinary  standing  position,  lifted  by  its  fore-limbs, 
or  allowed  to  stand  on  its  hind.  The  pulse  was  rapid,  very  feeble, 
and  irregular.  Both  jugulars  showed  a  marked  venous  pulse,  especiall}- 
in  their  lower  portions.  The  pulse  was  120,  the  respirations  thirty-six 
per  minute ;  the  temperature  39"  C.  (i02'2°  F.).  I  diagnosed  the 
condition  as  pericarditis,  probably  of  tuberculous  character  complicated 
with  ascites.     Injection  of  tuberculin  produced  no  reaction. 

On  the  third  day  I  successively  performed,  under  antiseptic  pre- 
cautions, puncture  of  the  abdomen  and  of  the  pericardium,  using  an 
aspirator.  I  slowl}- withdrew  from  the  abdomen  nearly  three  pints  of 
a  greyish  serous  fluid,  and  from  the  pericardium  twelve  fluid  ounces 
of  a  similar  liquid.  A  part  of  the  left  thoracic  wall,  as  large  as  the 
palm  of  a  man's  hand,  over  the  heart  region,  was  rubbed  with  anti- 


PKRICARDITIS    IN    THE    DOG.         •  165 

monial  ointment,  and  the  abdomen  was  bandaged.  The  food  con- 
sisted of  milk  and  a  Httle  raw  meat. 

This  treatment  gave  immediate  rehef.  Next  day  the  respirations 
were  only  30  and  freer,  the  pulse  was  100,  and  the  appetite  returned. 
The  animal  took  a  pint  of  milk  and  some  meat.  On  the  following 
days  slow  improvement  continued. 

Recovery  was  uneventful  ;  no  occasion  arose  for  repeating  the 
puncture,  the  liquid  left  in  the  pericardium  and  peritoneum  becoming 
reabsorbed.  A  month  later  the  animal  returned  home  cured.  It  had 
quite  recovered  its  appetite,  was  bright,  walked  and  trotted  without 
showing  dyspnoea,  and  the  impulse  and  sounds  of  the  heart  had 
become  normal.  We  heard  somewhat  later  that  the  animal  had 
recovered  its  condition  and  strength. 

In  addition,  however,  to  narrating  these  two  cases,  I  wish  to  direct 
your  attention  to  the  principal  varieties  of  pericarditis  in  the  dog,  and 
to  teach  you  the  lessons  of  my  own  experience. 

Though  very  generally  of  secondary  character,  and  due  either  to 
tuberculosis  or  some  other  infectious  disease  like  pneumonia,  rheu- 
matism, or  distemper,  pericarditis  is  sometimes  primary,  the  result  of 
cold  or  injury.  You  will  rarely  see  traumatic  pericarditis,  most  of  the 
cases  we  are  called  on  to  treat  being  attributed  to  chill.  As  in 
pleurisy,  pneumonia,  and  endocarditis,  cold  is  not,  however,  the  sole 
factor  in  producing  the  disease,  its  action  being  confined  to  exciting 
general  disturbance,  congestion,  etc.,  which  favour  and  render  possible 
infection  of  the  pericardium  by  microbes  brought  from  neighbouring 
or  distant  organs  through  the  circulation.  Pericarditis  a  frigore  is 
certainly  rare,  and  can  only  occur  in  animals  predisposed  to  it  by  their 
constitutional  condition,  though  its  occurrence  is  indisputable.  You 
will  see  it  especially  in  water-spaniels  and  sporting  dogs  used  in 
marshy  country. 

During  March,  1895,  I  made  a  post-mortcui  examination  of  a  little 
poodle,  in  which  exudative  pericarditis  had  been  produced  by  baths 
prescribed  for  skin  disease.  A  week  after  commencing  treatment  the 
patient  suddenly  showed  very  grave  symptoms,  which  were  attributed 
to  pleurisy.  Bathing  was  stopped,  and  the  animal  treated  for  the 
chest  affection  ;  but  the  treatment  proved  abortive,  and  death  occurred 
on  the  tenth  day.  The  body  was  brought  here.  The  pleurae  and  lungs 
were  healthy,  but  the  pericardium  was  acutely  inflamed  and  contained 
abundance  of  a  slightly  reddish  fibrinous  liquid,  in  the  precipitate  from 
which  I  found  streptococci.  There  were  no  tubercle  bacilli,  and  no 
tuberculous  lesions  in  any  of  the  organs. 


1 66  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

In  the  dog,  exudative  pericarditis  occurs  in  the  acute  and  chronic 
forms.     Attention  is  always  first  attracted  by  the  physical  symptoms. 

The  acute  form  is  indicated  by  loss  of  appetite,  weakness,  rapid 
breathing,  anxiety,  dyspnoea,  and  fever,  amounting  to  r^'^ — 2'^  C 
Physical  signs  soon  develop  indicating  its  character.  At  the  very 
commencement  auscultation  may  reveal  a  rubbing  sound,  produced  by 
friction  between  the  two  roughened  pericardial  layers  ;  but  this  sound 
is  fugitive,  and  can  rarely  be  detected.  Furthermore  it  is  not  constant, 
for  exudation  may  accompany  the  onset  of  the  disease.  At  this  initial 
stage  palpitation  may  also  occur,  particularly  when  the  patient  walks 
or  makes  an}-  marked  effort ;  percussion  sometimes  produces  pain. 

As  soon  as  the  pericardium  contains  a  certain  quantity  of  liquid, 
the  heart  is  thrust  upwards  and  a  little  forwards,  the  degree  of  dis- 
placement depending  on  the  amount  of  exudate.  The  pericardial  sac 
becomes  distended,  especially  about  its  base,  lifting  the  pulmonary 
lobes,  and  pushing  them  upwards  towards  the  vertebrae,  though  to  a 
much  less  degree  than  in  pleurisy.  Thus  on  palpation  of  the  pre- 
cordial region  the  heart's  impulse  appears  weak,  or  seems  lost.  On 
auscultation  the  normal  sounds,  clearly  detected  in  health  even  in 
very  small  patients,  are  dull,  distant,  and  smothered,  or  completely 
inaudible..  When  the  heart  is  but  slightly  compressed  the  pulse  pre- 
serves its  character  ;  but  as  soon  as  pressure  becomes  marked  the  pulse 
grows  small,  fugitive,  and  weak,  sometimes  almost  imperceptible  and 
uncountable. 

Compression  of  the  auricles — the  portions  of  the  heart  which  col- 
lapse most  readily — impedes  the  flow  of  blood,  produces  cyanosis, 
venous  pulse  in  the  jugulars,  and  mechanical  dyspnoea  owing  to  stasis 
of  blood  in  the  lungs.  The  symptoms  of  oppression  at  first  seen  are  un- 
"doubtedly  of  reflex  origin,  due  to  the  pain  in  the  inflamed  pericardium. 

If  not  treated,  acute  pericarditis  may  rapidly  lead  to  death,  some- 
times in  less  than  a  week.  It  may  also  (though  exceptionally)  ter- 
minate in  recovery,  the  exudate  becoming  reabsorbed,  the  symptoms 
gradually  diminishing  and  finally  disappearing.  In  certain  cases  it 
assumes  the  chronic  form. 

The  variety  of  pericarditis  to  which  the  term  hemorrhagic  has  been 
applied  is  characterised  by  a  reddish,  sanguineous  exudate,  and  occurs 
somewhat  frequently  in  the  dog.  During  the  course  of  the  last  two 
3'ears  I  have  seen  five  cases.  In  three  the  pericardial  inflammation 
was  of  tuberculous  origin,  and  in  one  there  was  no  other  tuberculous 
focus  save  in  the  pericardium.  In  two  cases  the  disease  was  of  a 
special  character,  independent  of  tuberculosis.  The  haemorrhage 
occurring  during  the   course    of  the    disease    originates    in    the   very 


PERICARDITIS    IN    THE    DOG.  167 

vascular  and  fragile  new  membranes  which  de\elop  on  the  surface  of 
the  pericardium,  especially  towards  the  base  of  the  heart,  at  the  point 
where  the  serous  membrane  is  reflected.  This  form  is  always  very 
grave.     The  five  patients  which  I  saw  all  died  rapidly. 

In  1894  I  had  sent  to  me  the  bod}-  of  a  bitch  which  had  died  from 
hccmorrhagic  pericarditis,  and  in  which  the  peritoneal  exudate  was 
very  abundant.  A  year  before  I  had  tapped  this  animal  for  abdominal 
ascites,  apparently  curing  her — at  least  for  a  period  of  six  months.  In 
this  case,  again,  we  found  no  tuberculous  lesion,  and  animals  inocu- 
lated with  the  exudate  gave  no  result. 

In  a  considerable  number  of  instances,  instead  of  following  this- 
well-marked  course,  pericarditis  assumes  a  chronic  character  from  the 
beginning.  Its  onset  is  insidious,  its  course  slow;  and  until  the 
exudate  is  sufficiently  abundant  to  produce  difficulty  in  breathing,, 
it  remains  unrecognised.  Then  on  methodical  examination  one 
notes,  as  in  the  acute  form,  certain  signs  furnished  by  auscultation 
and  percussion.  At  a  more  advanced  stage  the  physical  signs  become 
aggravated,  and  are  supplemented  by  loss  of  appetite,  feebleness, 
emaciation,  and  swelling  of  the  limbs — final  complications  which  you 
have  seen  in  several  patients. 

The  dog  occasionally  suffers  from  "dry"  pericarditis  of  simple  or 
tuberculous  character,  which  ends  by  producing  numerous  adhesions 
between  the  two  opposing  la)ers  of  the  pericardium.  In  this  form 
functional  disturbance  is  seldom  much  marked,  and  the  disease  some- 
times remains  unrecognised  until  post-mortem  examination.  Even  in 
the  first  stages  digital  pressure  over  the  intercostal  spaces  of  the  pre- 
cordial region  produces  no  marked  pain.  The  only  constant  sign  is 
the  rubbing  sound,  which  usually  persists  for  a  considerable  time,  and 
may  occur  either  during  systole  or  diastole,  but  is  always  synchronous 
with  the  mo\'ement  of  the  heart — a  character  differentiating  it  from  the 
pleuritic  rubbing  sound  which  is  synchronous  with  respiration.  When 
adhesions  have  occurred  the  heart's  action  seems  feeble,  or  the  cardiac 
impulse  may  be  imperceptible  on  palpation.  You  noted  this  latter 
S3T"nptom  in  a  tuberculous  dog  killed  a  few  \Neeks  ago,  at  the  post- 
mortem examination  of  which  we  found  very  complete  adhesion  of  the 
two  pericardial  layers.  At  a  later  stage  adhesion  between  these  layers 
may  be  complicated  by  degeneration  of  the  heart  muscle,  producing 
cyanosis,  dyspnoea,  ascites,  and  oedema  of  the  limbs. 

In  general,  when  the  veterinar\'  surgeon  is  called  on  to  examine  a 
dog  affected  with  exudative  pericarditis,  the  disease  has  already  been  in 


1 68  CLINICAL    VETERINARY    .MEDICINE    AND    SURGERY. 

existence  for  some  time,  occasionally  for  several  weeks  ;  and,  provided 
he  makes  a  complete  examination  of  the  patient,  and  does  not  forget 
the  heart,  a  careful  consideration  of  the  signs  furnished  by  palpation, 
percussion,  and  auscultation  should  enable  him  to  arrive  at  a  correct 
diagnosis.  Ascites  is  often  the  most  striking  symptom,  and  puts  one 
on  the  right  path.  It  is  usually  easy  to  differentiate  between  pericar- 
ditis and  pleurisy.  In  pleurisy  with  moderate  exudation,  resembling 
that  of  pericarditis,  the  zon.e  of  dulness  changes  with  the  animal's 
position.  By  standing  the  animal  on  its  hind  legs  the  heart-sounds 
and  vesicular  murmur  become  readily  perceptible,  while  the  upper  part 
of  the  thorax  is  resonant ;  in  the  normal  standing  position  the  reso- 
nance disappears  or  becomes  dulled. 

Pericarditis  having  been  diagnosed,  the  question  remains  whether 


Fig.  17. — Chest  bandage. 

or  not  it  be  of  tuberculous  character.  The  patient's  bodily  condition, 
the  clinical  signs,  and  the  history  only  form  a  basis  for  presumptions. 
But  in  most  cases  the  matter  can  be  solved  by  an  injection  of  tuber- 
culin ;  and  even  when  this  appears  to  fail,  recourse  may  be  had  to 
inoculation  of  a  guinea-pig  with  a  little  pericardial  serosity. 

As  I  said  at  the  commencement,  most  of  our  patients  are  affected 
with  pericarditis  complicated  with  ascites.  Unless  the  pericardial 
symptoms  appear  menacing,  tapping  may  be  deferred,  and  attempts 
made  to  assist  reabsorption  of  exudate  by  counter-irritants,  diuretics 
and  purgatives.  I  am  in  the  habit  of  rubbing  the  precordial  region  with 
antimonial  ointment,  and  to  prevent  the  animal  licking  it,  I  apply  a 
bandage  over  the  spot  (Fig.  17).  I  prefer  this  to  cold  compresses  or 
sinapisms.  In  addition  to  milk  diet,  I  prescribe  internally  calomel  or 
bicarbonate  of  soda  and  digitalis. 


PERICARDITIS    IN    THE    DOc;.  169 

When,  despite  treatment,  the  exudate  increases  and  the  symptoms 
become  more  marked  and  alarming,  or  when  even  on  first  examination 
the  general  condition  appears  dangerous,  I  puncture  the  pericardium. 

Operation  is  as  follows : — The  precordial  region  is  prepared  by 
clipping  away  the  hair,  and  shaving  the  skin  a  little  below  the  centre  of 
the  zone  of  dulness  for  a  distance  of  two  or  three  square  inches.  The 
parts  are  afterwards  washed  with  alcohol,  and  with  a  'i  per  cent,  solu- 
tion of  sublimate.  I  prefer  an  aspirator  provided  wdth  an  india-rubber 
tube,  and  I  proceed  as  you  saw  in  the  case  of  our  last  patient.  The 
air  being  exhausted  from  the  cylinder  of  the  aspirator,  the  instrument 
is  passed  to  an  assistant ;  I  introduce  the  point  of  the  needle  at  the 
centre  of  the  prepared  surface,  through  the  fifth  intercostal  space  three 
or  four  fingers'  breadth  above  the  lower  margin  of  the  thorax.  As  soon 
as  its  end  has  fairly  entered  the  thoracic  wall  I  open  the  tap  connected 
with  the  aspirator  ;  then  I  very  gently  push  forward  the  needle  until 
liquid  appears  in  the  glass  index  of  the  rubber  tube.  Operating  in  this 
way  the  needle  need  only  just  enter  the  pericardium,  and  with  a  short 
point,  injury  of  the  heart  (which  is  always  pushed  upwards  and  shortened 
in  its  vertical  axis)  need  not  be  feared.  Furthermore,  by  using  a  small 
needle,  fluid  is  very  slowly  withdrawn  and  danger  of  syncope  prevented. 
In  the  absence  of  an  aspirator,  puncture  may  be  effected  with  a  fine 
trocar.  After  operation  the  wound  is  closed  by  painting  with  collodion, 
and  the  parts  covered  with  a  cotton-w'ool  dressing. 

Should  the  exudate  again  form,  reproducing  the  symptoms,  operation 
must  be  repeated.  To  prevent  further  recurrence  in  such  a  case,  a  few 
drachms  of  very  dilute  iodine  solution  or  some  other  antiseptic  liquid 
may  be  injected  into  the  pericardial  sac  after  removing  the  exudate. 

During  the  following  days  the  patient  is  fed  on  milk,  milk  prepara- 
tions, meat  juice,  or  fragments  of  raw  meat.  When  appetite  returns, 
more  substantial  food  and  tonics  may  be  given. 

When  pericarditis  is  complicated  with  ascites  I  generally  remove 
the  peritoneal  fluid  by  tapping  the  abdomen,  but  this  is  not  always 
necessary.  Once  the  pericardium  is  relieved,  the  peritoneal  exudate 
tends  naturally  to  become  absorbed.  Its  disappearance  is  assisted  by 
administration  of  diuretics. 

The  reason  why  treatment  so  generally  fails  is  that,  in  the  majority 
of  cases,  pericarditis  is  produced  by  tuberculosis.  In  such  case,  puncture, 
whether  or  not  followed  by  iodine  injections,  can  only  produce  tem- 
porary improvement.  Even  when  tuberculosis  is  exclusively  confined 
to  the  pericardium  (I  have  seen  a  case  of  this  kind)  the  liquid  is  repro- 
duced, and  the  patient  dies  from  complications  of  pericarditis,  or  from 
progressive  emaciation. 


XXVI.— PNEUMONIA    IN    THE    HORSE. 

At  the  present  time  we  have  in  hospital  three  horses  which  have 
recently  been  attacked  with  pneumonia,  affording  us  a  particularly 
favourable  opportunity  for  studying  the  disease.  You  have  closely 
examined  all  three,  and  have  seen  that  as  regards  the  symptoms  and 
course  of  the  disease  the}-  present  notable  differences. 

The  first  of  these  patients,  a  nine-year-old  gelding,  entered  on  the 
14th  April  suffering  from  pneumonia  of  three  days'  standing.  It  was 
very  dull,  but  still  took  note  of  what  went  on  around  it.  The  conjunc- 
tivae were  saffron -yellow  in  colour,  the  respiration  and  circulation 
accelerated,  the  pulse  strong  and  regular.  From  both  nostrils,  and 
especially  from  the  right,  a  little  yellowish  rusty  discharge  escaped. 
Percussion  showed  partial  dulness  in  the  lower  third  of  the  right  lung. 
On  auscultation  a  moist  crepitant  rale  was  heard ;  the  temperature  was 
40°  C.  (104°  F.). 

We  were  informed  that  on  the  previous  day  the  animal  was  seen  to 
be  ill.  It  had  been  at  work  from  morning  till  night,  and  had  been 
caught  in  several  showers  of  rain.  When  placed  in  a  box  after  exa- 
mination the  patient  took  some  mash,  ha}'  tea,  and  a  few  oats.  Treat- 
ment was  as  follows  : — A  mustard  plaster  was  applied  to  the  lower  half 
of  the  chest,  six  ounces  of  '8  per  cent,  salt  solution  were  subcutane- 
ously  injected,  and  one  and  a  half  ounces  of  bicarbonate  of  soda  were 
given  internally.  Food  consisted  of  six  quarts  of  milk  per  day,  bran 
mashes,  hay  tea,  and  chilled  water  ad  libitum. 

Next  day  the  general  condition  remained  practically  unaltered.  The 
respiration,  circulation,  and  temperature  had  undergone  no  marked 
change.  On  auscultation  a  tubal  sound  was  heard  opposite  the  centre 
of  the  left  lobe.  In  the  upper  third  of  this  lobe,  and  throughout  the 
right  lobe,  the  vesicular  murmur  was  exaggerated. 

On  the  following  day  the  animal  appeared  distinctly  better  and 
brighter.  I  drew  your  attention  to  the  tubal  sound,  which,  being  heard 
in  the  centre  of  an  otherwise  absolute!}'  silent  area,  was  unusualh'  well 
defined.  The  appetite  was  good.  The  temperature  had  fallen  half  a 
degree  (C). 


SIMPLE    PNEUMONIA    IN    THE    HORSE.  17I 

On  the  fourth  da}-  (that  is  the  seventh  of  the  disease)  improvement 
was  again  marked.  The  animal  was  brighter  and  more  h\ely.  and  ate 
all  its  food.  The  temperature  was  only  38'5°  C.  (ioi"3°  F.),  the  tubal 
sound  was  feebler,  and  crepitation  was  returning. 

The  last  S3-mptoms  soon  disappeared,  and  the  patient  being  con- 
valescent left  hospital.     It  had  remained  about  twelve  days. 

This  first  horse  illustrated  in  a  remarkable  degree  the  regular  deve- 
lopment of  pneumonia  ;  it  was,  in  fact,  a  typical  case  of  what  is  termed 
simple  pneumonia. 

The  second  patient,  brought  to  the  College  on  the  evening  of  the- 
19th  April,  was  a  five-year-old  entire  horse,  from  a  stable  in  which, 
during  the  preceding  weeks,  several  cases  of  pneumonia  had  occurred. 
On  the  morning  of  entering  hospital  the  horse  had  made  a  journe}-  at  a 
slow  trot,  and  though  it  appeared  less  willing  than  usual,  this  was 
attributed  to  fatigue  and  the  hard  work  of  the  previous  few  days.  On 
returning  at  midda}-  it  refused  food,  and  was  seen  to  be  dull  and  to  be 
"  blowing  "  slightly. 

At  six  o'clock  when  we  examined  it  the  animal  showed  unmistakable 
signs  of  a  grave  morbid  condition,  which,  according  to  the  information 
furnished,  would  appear  to  have  been  pneumonia.  The  patient  was 
greatly  depressed,  the  conjunctiva  injected,  the  mouth  dr}  and  hot,  the 
pulse  seventy  per  minute,  the  respirations  forty-eight,  and  the  tempera- 
ture 40*3'^  C.  (I04"3°  F.).  Auscultation  and  percussion  of  the  chest 
revealed  no  abnormal  sound  either  in  the  lungs  or  the  heart.  All  that 
was  noticed  was  a  certain  exaggeration  of  the  \esicular  murmur,  and 
impulse  of  the  heart. 

I  prescribed  mustard  plasters  to  the  chest,  friction  with  mustard  to 
the  limbs,  and  the  internal  administration  of  six  ounces  of  alcohol,  four 
drachms  of  sulphate  of  quinine,  and  one  and  a  half  ounces  of  bicar- 
bonate of  soda.  The  animal  \vas  given  gruel  and  milk  e\ery  two  hours. 
At  a  later  stage  we  also  had  recourse  to  digitalis,  calomel,  subcutaneous 
injections  of  serum  and  of  ether,  and  finally  to  warm  carbolic  enemata. 

On  the  two  following  days  the  temperature  remained  between  40*5° 
and  41°  C.  (104-9°  and  105-8°  F.),  the  respirations  thirty-five  to  forty^ 
and  the  pulse  seventy  to  eighty  per  minute.  There  was  trifiing  cough 
and  very  little  discharge.  On  the  22nd  percussion  revealed  dulness 
o\er  the  lower  half  of  both  pulmonary  lobes ;  on  auscultation  moist 
crepitus  was  heard.  During  the  following  days  the  area  of  dulness  and 
crepitation  increased,  especially  on  the  right  side ;  respiration  became 
difficult,  expiration  sighing,  and  the  heart's  action  violent,  while  fever 
remained   intense.     Each  afternoon   the   patient  was   well  co\'ered  up,. 


172  CLINICAL  vp:terinary  medicinp:  and  surgery. 

taken  out  of  the  stable,  and  left  for  some  hours  in  the  open  air.  On  the 
fifth  and  six  days  we  noted  on  the  right  side  a  slight  deep-seated  tubal 
sound,  although  crepitation  persisted  in  parts  of  the  lower  region  of  both 
lobes.  On  the  eighth  day  the  temperature  still  remained  at  40°  C. 
(104°  F.).  Next  day  it  began  to  decline,  but  the  general  and  local 
symptoms  diminished  less  rapidly  than  in  the  first  patient,  only  disap- 
pearing completely  on  the  fourteenth  day. 

In  our  third  patient  the  disease  behaved  very  much  as  in  the 
preceding.  Both  lungs  were  affected,  the  left  more  severely  than  the 
right.  For  several  days  there  was  marked  depression  and  cardiac 
disturbance.  The  temperature  rose  to  4i'4°  C.  (io6"5°  F.).  defer- 
vescence only  setting  in  on  the  eighth  day.  On  the  twelfth  the  more 
important  functions  had  become  normal. 

Although  these  two  patients  showed  no  symptoms  pointing  to  the 
existence  of  grave  lesions  in  other  organs  than  the  lungs,  they  had 
suffered  from  contagious  pneumonia,  contracted  in  their  own  stable. 

During  the  last  few  months  you  have  seen  a  number  of  other  cases 
■of  sporadic  and  contagious  pneumonia.  I  called  your  attention  to  their 
special  features.  I  showed  you  that  in  simple  pneumonia  the  inflam- 
matory centre  is  early  revealed  and  limited,  the  course  is  regular  and 
typical,  the  defervescence  is  clearly  marked  and  occurs  on  a  fixed  date, 
complications  are  rare,  convalescence  is  short,  prognosis  favourable,  and 
recovery  almost  constant.  On  the  other  hand,  in  contagious  pneumonia 
the  pulmonary  lesion  is  generally  at  first  deep-seated,  invades  neigh- 
bouring parts,  or  occurs  at  several  points  — is,  in  a  word,  multiple;  the 
course  is  atypical  or  protracted,  the  defervescence  slow,  and  sometimes 
attended  by  relapses ;  complications  are  numerous  ;  convalescence  is 
slow,  and  the  prognosis  grave. 

Future  investigations  may  possibly  establish  the  essential  identity  of 
these  two  conditions — the  unicity  of  pneumonia  in  the  horse  ;  possibly 
they  will  prove  that  simple  and  contagious,  benign  and  malignant 
pneumonias  are  all  produced  by  the  same  microbe,  the  virulence  of  which 
becomes  diminished  or  exalted  under  the  influence  of  ascertained  or 
occult  conditions.  But  up  to  the  present  we  have  only  vague  guidance  on 
these  points,  and  although  from  simple  clinical  signs  it  is  sometimes 
difficult,  and  even  impossible  to  say  to  which  variety  a  particular  case 
belongs,  I  risk  the  chance  of  criticism,  and  consider  it  better  to  study 
the  disease  under  the  two  forms  of  simple  or  sporadic,  and  contagious 
pneumonia.      Let  us  begin  with  the  former. 

Acute  Sporadic  Pneumonia  (also  termed  Fibrinous,  or  Croupous)  is 


SIMPLK    PNEUMONIA    IN    THE    HORSE.  1 73; 

a  common  disease  in  the  horse.  Its  frequency  is  explained,  especially 
in  horses  used  for  heavy  work  in  large  towns,  by  the  changes  of  tem- 
perature to  which  they  are  exposed,  by  the  very  active  function  of  the 
lung  during  work,  and  by  the  susceptibility  to  cold  presented  by  those 
kept  in  ill-ventilated  stables. 

Liability  to  pneumonia  varies  with  age.  The  disease  is  commonest 
in  young  unseasoned  animals,  which  are  particularly  sensitive  to  the 
action  of  changes  in  the  weather,  and  in  which  the  lung  has  not  yet 
become  accustomed  to  active  work.  In  them,  and  in  old  animals  which 
have  arrived  at  the  decadent  period,  the  disease  is  gravest.  Among 
predisposing  influences  are  close,  low-roofed,  badly  ventilated  stables ; 
debility ;  sluggish  circulation ;  and  various  other  causes  which 
commonly  favour  the  development  of  visceral  diseases. 

The  chief  exciting  cause  of  pneumonia  is  the  action  of  cold.  In 
this  respect  authors  are  unanimous,  and  in  consequence  the  disease  has 
often  been  termed  Pneumonia  a  frigorc.  The  largest  number  of  cases, 
occur  during  the  first  four  and  last  three  months  of  the  year.  It  is  par- 
ticularly frequent  at  the  seasons  of  greatest  changes  in  temperature — at 
the  beginning  of  spring,  and  in  the  autumn.  Sudden  changes  of  tempera- 
ture, and  rain  or  moist  weather,  appear  more  dangerous  than  prolonged 
uniform  cold.  Chills,  thus  produced,  may  be  assisted  by  other  influences, 
especially  by  functional  hyper-activity  of  the  lung.  The  most  fa^■ourable 
conditions  for  producing  pneumonia  are  found  when  animals  have  been 
clipped,  and  whilst  sw^eating  are  wetted  b}-  a  shower,  or  suddenly 
exposed  to  a  current  of  cold  air.  It  is  said  that  since  the  custom  of 
clipping  has  become  general,  pneumonia  has  diminished  in  frequence. 
Nevertheless  cases  occur  where  it  clearly  appears  to  have  favoured 
inflammation  of  the  lung.  In  one  of  our  patients,  which  had  not  been 
overworked  or  exposed  to  showers,  pneumonia  developed  ten  days  after 
clipping.  Many  similar  cases  have  been  observed  amongst  the  horses 
of  the  great  Omnibus  Company  of  Paris,  where  clipping  has  been 
given  up. 

For  a  long  time  it  was  belie\ed  that  the  action  of  cold  was  alone 
sufficient  to  produce  pneumonia,  but  this  is  erroneous.  The  constant 
failures  which  followed  attempts  to  produce  pneumonia  experimentally 
were  explained  by  a  special  resistance  of  the  organism,  and  by  the 
absence  of  conditions  which  predispose  to  the  disease.  Bacteriological 
experiments  in  man  have,  however,  shown  the  existence  of  another 
factor,  which  is,  in  fact,  the  causa  causans.  They  proved  that  pneu- 
monia is  an  infectious  disease,  produced  by  the  entrance  into  and 
growth  within  the  lung  of  a  special  microbe — the  pneumococcus. 

The  first  experiments  on  this  point  date  from  1877.     Some  years. 


174  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

later  Friedlander  discovered  in  centres  of  pulmonary  inflammation  an 
encapsuled  bacillus,  which  he  regarded  as  the  cause  of  the  disease. 
Talamon  afterwards  found  that  the  microbe  of  the  disease  is  a  coccus 
occurring  in  the  form  of  little  elongated  grains,  isolated  or  arranged  in 
couples,  and  enclosed  in  a  capsule  ;  it  colours  readily  with  aniline  dyes 
and  by  Gram's  method.  This  pneumococcus  had  previously  been  dis- 
covered by  Pasteur  in  normal  saliva.  It  exists  in  the  bucco-pharyngeal 
cavity,  and  has  also  been  found  in  the  nasal  fossae,  Eustachian  tubes, 
and  even  in  the  bronchi.  Nor  is  its  field  of  pathological  activity  limited 
to  the  lung.  It  may  produce  pleurisy.  It  is  also  capable  of  passing 
into  the  blood-stream  and  causing  other  visceral  diseases  like  endo- 
carditis, nephritis,  and  meningitis — only  to  mention  the  principal. 
Cultures  of  this  pneumococcus  injected  into  the  blood  produce  pneu- 
monia, sometimes  complicated  with  pleurisy,  endocarditis,  and  peri- 
carditis. 

In  human  pneumonia  it  is  constantly  present,  and  without  it  the 
disease  does  not  develop.  Invasion  of  the  lung  is  favoured  by  cold, 
which,  however,  only  acts  as  an  exciting  cause  by  producing  vascular 
or  cellular  disturbance,  and  by  momentarily  diminishing  the  resistance 
of  the  organism.  The  pneumococcus  does  not  always  act  alone,  being 
sometimes  accompanied  by  streptococci  or  staphylococci.  Even  when 
the  pathogenic  organisms  are  confined  to  the  lung  grave  disturbance 
may  be  produced  in  other  viscera  or  tissues  by  the  toxins  they 
elaborate — that  is,  by  soluble  poisons,  the  injurious  effects  of  which 
are  specially  marked  in  the  heart  and  kidneys. 

Simple  pneumonia  in  the  horse  is  certainly  an  infectious  disease 
also,  but  its  microbe  has  not  yet  been  satisfactorily  identified.  In 
hepatised  areas  various  germs  are  found,  among  others  a  micrococcus 
which  presents  certain  analogies  with  the  pneumococcus  of  man,  and 
a  diplo-streptococcus  which,  according  to  certain  authors,  is  only  a 
modified  form  of  the  microbe  of  contagious  pneumonia. 

It  is  possible  that,  as  in  man,  the  microbe  which  produces  simple 
pneumonia  acquires  greater  virulence  by  growth  in  the  favourable 
medium  offered  by  the  inflamed  pulmonary  tissue,  and  that,  having 
gained  this  increased  activity,  it  may  unaided  produce  pneumonia  in 
animals  exposed  to  infection.  Such  infection  might  easily  occur 
through  the  medium  of  the  discharge,  which  always  contains  a  certain 
number  of  the  infective  organisms. 

Against  this  theory  of  the  contagious  character  of  simple  pneu- 
monia, suggested  by  Cagnat  in  1884,  have  been  advanced  innumerable 
recorded  cases  where  the  disease  remains  isolated,  and  where,  in  spite 


SIMPLE    PNEUMONIA    IN    THE    HORSE. 


175 


of  the  cohabitation  of  an  affected  patient  with  other  horses  of  all  ages, 
the  latter  successfully  resist.  Many  continue  to  consider  contagious 
pneumonia  and  simple  pneumonia  (or  pneumonia  ^7  frigore)  as  different 
affections,  chiefly  because  the  latter  has  not  the  eminently  infectious 
character  of  the  former ;  but  also  because  it  generally  shows  special 
clinical  and  anatomical  pathological  characters.  Nevertheless  I 
repeat,  that  very  often  when  examining  a  patient  it  is  impossible  to 
decide  by  the  clinical  symptoms  alone  what  form  of  disease  we  have  to 
deal  with,  and  it  is  now  known  that  lobar  hepatisation  is  not  an  ana- 
tomical character  peculiar  to  pneumonia  a  frigore. 

Many  authors  state  that  a  first  attack  predisposes  to  a  return  of  the 
disease.  This  opinion,  founded  on  the  widely  accepted  belief  that  after 
inflammation  the  lung  remains  more  or  less  injured  and  enfeebled,  is  in 
no  way  conflrmed  by  clinical  observation.  Not  only  have  I  failed  to 
observe  this  predisposition,  but  I  believe,  on  the  contrary,  that  a  horse 
which  has  previously  suffered  from  pneumonia  is  less  exposed  to  the 
disease,  and  that  it  acquires  a  certain  degree  of  immunity.  I  consider 
that  in  animals  which  have  made  a  good  recovery  from  pneumonia  we 
should  regard  the  traces  left  by  blisters,  etc.,  on  the  chest  as  an  indica- 
tion of  greater  resistance,  instead  of  considering  them,  as  many  prac- 
titioners do,  as  signs  of  grave  depreciation.  And  when  the  disease 
returns  in  such  horses,  the  second  attack  is  almost  always  benign  in 
character. 

Simple  pneumonia  is  ushered  in  by  general  disturbance,  often  by 
rigors,  soon  followed  by  gradual  rise  in  temperature.  The  animals 
tremble  slightly ;  the  majority  are  depressed  and  stiff,  the  appetite 
falls  off,  the  mouth  is  hot  and  dry,  the  bowels  are  constipated  ;  the 
conjunctiva  is  injected,  or  yellowish  in  colour,  and  the  skin  is  warm 
and  moist.  The  respiratory  movements  are  less  frequent,  expiration 
is  sometimes  sighing,  there  is  often  more  or  less  oppression,  and  a 
dry,  painful,  deep  cough.  The  pulse  is  rapid,  full  and  strong.  On 
auscultating  the  lung  the  vesicular  murmur  is  found  to  be  diminished 
in  the  lower  portion  of  one  or  other  lobe,  sometimes  of  both.  Per- 
cussion reveals  lessened  resonance.  These  symptoms  become  gradually 
more  marked,  and  in  twenty-four  to  forty-eight  hours  others  appear. 
A  reddish  or  rusty-coloured  discharge  runs  from  the  nostrils,  the  colour 
being  due  to  blood  elements  contained  in  the  pulmonary  exudate. 
Drying  around  the  nostrils  it  forms  a  friable  crust,  resembling  saffron, 
sulphur,  or  iron  rust  in  colour.  As  a  general  rule  this  discharge 
remains  somewhat  abundant  for  several  days.  Sometimes  a  sanguino- 
lent  discharge  is  seen  from  the  outset. 


176  CLINICAL    VETEKINARV    MEi:)ICINE    AND    SURCIERV. 

Auscultation  of  the  lower  portion  of  the  affected  lung  re\eals  a 
well-marked  moist  crepitant  rale  during  inspiration,  and  immediatel}- 
after  the  paroxysms  of  coughing.  At  this  point  partial  or  almost 
complete  dulness  is  noted  on  auscultation  ;  while  in  the  upper  zone, 
which  has  undergone  no  change,  the  vesicular  murmur  is  increased. 

Hepatisation  commences  on  the  fourth  or  fifth  day.  The  fever 
persists,  the  pulse  and  respiration  reach  their  highest  point,  at  certain 
moments  expiration  is  sighing  ;  the  pulse  is  usually  strong  and  full, 
but  sometimes  small  and  soft  ;  cough  is  less  frequent  and  discharge 
disappears,  because  the  exudate  collected  in  the  pulmonary  alveoli 
coagulates  there.  On  auscultation  over  the  large  bronchi  and  surround- 
ing parts  one  hears  during  inspiration  and  expiration,  or  onl}-  during 
the  first  part  of  the  latter,  an  abnormal  sound,  sometimes  strong, 
sometimes  feeble  and  deep-seated — the  tubal  murmur.  On  the 
diseased  side  the  lower  part  of  the  lung  is  silent,  or  only  abdominal 
sounds  transmitted  by  the  solidified  lung  are  audible ;  in  the  upper 
healthy  part  the  vesicular  sound  is  increased  ;  towards  the  borders  of 
the  hepatised  zone  the  crepitant  rale  often  persists.  On  percussion 
dulness  is  complete  throughout  the  entire  pulmonary  area  invaded. 

The  constitutional  symptoms  are  usually  most  marked  from  the 
fourth  to  the  sixth  day.  ^^'hen  the  disease  develops  regularl}'  and 
promises  a  favourable  termination,  diminution  commences  from  about 
the  seventh  day,  marking  the  crisis.  The  patient  is  livelier,  takes  note 
of  its  surroundings,  shows  better  appetite,  respiration  is  less  rapid  and 
painful,  the  pulse  less  frequent,  and  the  temperature  falls.  The  cough 
returns,  or  if  it  has  persisted  becomes  more  frequent,  and  discharge 
reappears — now  usually  mucous  in  character,  greyish,  sometimes  rust}- 
or  streaked  with  blood.  The  mouth  is  cooler,  the  excretions  are 
moister,  occasionally  diarrhoea  occurs.  The  urine  increases  in  quantit}', 
and  through  it  are  eliminated  certain  of  the  toxic  products  accumu- 
lated in  the  body.  In  some  patients  sweating  occurs,  in  others  little 
subcutaneous  abscesses,  termed  critical  abscesses,  appear  in  different 
regions.  On  auscultation  the  crepitant  rale  begins  to  replace  the  tubal 
murmur  formerly  heard,  and  gradually  advances  from  above  down- 
wards throughout  the  entire  pulmonary  area  invaded,  being  in  its  turn 
soon  replaced  by  the  vesicular  murmur.  The  percussion  dulness 
simultaneously  decreases,  and  in  a  few  days  the  sounds  again  become 
normal. 

Comparison  of  a  certain  number  of  cases  of  simple  uncomplicated 
pneumonia  shows  that  in  this  disease  the  temperature  curve  is  typical. 
It  steadily  rises  from  the  outset,  reaches  its  highest  point  with  con- 
siderable   rapidity,   remains  for  some  days  with    slight    morning  and 


SIMPLE    PNEUMONIA    IN    THE    HORSE.  1 7/ 

evening  oscillations,  then  on  the  fifth  to  seventh  day  suddenly  and 
rapidly  falls.  The  temperature  often  diminishes  two  to  three  degrees  in 
forty-eight  hours.  In  exceptional  cases  it  falls  below  normal,  but  soon 
returns  to  that  point. 

Convalescence  is  short.  Animals  can  generally  return  to  work  at 
the  end  of  a  fortnight. 

Such  is  the  regular  course  of  simple  pneumonia.  It  falls  naturally 
into  three  periods — invasion,  hepatisation,  and  resolution,  which 
succeed  one  another  at  almost  fixed  intervals.  Provided  the  patient  is 
kept  quiet  and  under  good  hygienic  conditions  from  the  outset,  the 
disease  almost  always  assumes  this  regular  form,  independently  of 
treatment. 

In  certain  cases  pneumonia  does  not  pass  through  all  the  above 
stages.  It  may  become  arrested,  and  resolution  occur  before  the  period 
of  hepatisation  is  arrived  at.  Under  such  circumstances  recovery 
is  exceptionally  rapid.  This  variety  has  been  termed  ephemeral  or 
abortive  pneumonia.  You  saw  a  case  in  one  of  our  patients ;  moist 
crepitation  persisted  in  the  lower  part  of  the  left  lung  for  two  days,, 
and  was  then  suddenly  replaced  by  the  vesicular  murmur. 

In  some  cases  complications  occur.  Diffuse  pulmonary  congestion,, 
oedema  of  the  lung,  or  myocarditis  may  produce  asphyxia  and  death. 
Endocarditis,  pleurisy,  synovitis,  arthritis,  and  para-  or  meta-pneu- 
monic  localisations  are  rarer  than  in  contagious  pneumonia. 

Suppuration  in  the  hepatised  parenchyma  is  undoubtedly  due  to 
secondary  infection  by  streptococci  or  staphylococci,  and  forms  a  very 
rare  complication.  M.  Trasbot  has  only  seen  seven  cases  in  a  total  of 
i68  personal  observations.  It  is  marked  by  sudden  aggravation  of 
symptoms ;  the  fever  increases,  the  skin  becomes  hot  and  dry,  or  from 
time  to  time  moistened  with  sweat.  Signs  of  excitement  may  occur, 
but  most  frequently  the  patient  is  profoundly  depressed.  Appetite  is 
completely  lost  ;  thirst  is  marked  ;  the  heart's  action  becomes  strong 
and  rapid,  the  pulse  more  and  more  feeble,  the  respiration  very  rapid, 
short,  and  tremulous.  On  auscultation  a  gurgling  or  amphoric  sound 
can  be  heard;  on  percussion  a  "  hniit  de  pot  fclc  "  (cracked-pot  sound). 
In  addition,  there  is  often  a  purulent  greyish  or  sanguinolent  dis- 
charge. When  the  abscess  breaks  into  a  bronchus  its  contents  may 
be  discharged  through  the  trachea,  and  recovery  is  possible.  But 
usually  the  hepatised  portions  of  lung  become  infiltrated  with  pus,  or 
purulent  pleurisy  develops  and  the  animal  succumbs. 

Pulmonary  gangrene  is  scarcely  commoner  than  abscess  formation. 

M 


T78  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

Among  igo  patients  treated  in  his  clinique,  M.  Trasbot  only  saw  twelve 
cases.  It  produces  general  symptoms  resembling  those  of  pulmonary 
suppuration,  and  almost  always  rapidly  leads  to  death.  The  principal 
symptoms  are  intense  fever,  with  marked  oscillation  of  temperature  ; 
profound  depression  ;  violent  heart's  action  ;  loss  of  pulse  ;  coldness  of 
the  extremities,  and  double-sided  putrid  discharge  from  the  nostrils. 
It  is  well  to  remember,  however,  that  putrid  discharge  is  not  (as  many 
believe)  an  infallible  sign  of  pulmonary  gangrene  ;  it  may  result  from 
putrefaction  of  exudate  in  the  dilated  bronchioles. 

Simple  pneumonia  very  seldom  assumes  the  chronic  form.  When 
this  occurs  certain  symptoms  disappear,  but  the  cough,  discharge,  and 
difficulty  in  breathing  persist,  and  the  animals  remain  thin,  feeble,  and 
incapable  of  any  considerable  effort. 

Let  us  now  glance  at  the  anatomical  changes  during  the  different 
stages  of  simple  pneumonia.  I  have  said  that  the  disease  is  usually 
localised  in  one  lobe,  of  which  a  greater  or  less  area  is  invaded  ;  it 
never  occurs  at  several  irregular  centres,  as  is  often  the  case  in  con- 
tagious pneumonia. 

During  the  period  of  engorgement  the  diseased  portion  of  lung  is 
hyperaemic,  iniiltrated,  and  cedematous.  It  seems  swollen  and  deep 
red  or  violet  in  colour ;  its  tissue  is  denser,  firmer,  less  elastic,  and  less 
crepitant  than  usual.  Sections  are  smooth,  of  a  livid  red  or  marbled 
appearance,  and  the  cut  surfaces  discharge  large  quantities  of  reddish 
sanguinolent  or  frothy  serosity.  The  alveolar  texture  of  the  lung, 
however,  can  still  be  distinguished.  Microscopic  examination  shows 
the  capillary  vessels  to  be  dilated,  engorged  with  blood,  or  ruptured. 
The  epithelium  lining  the  alveoli  is  partly  shed,  and  the  spaces  them- 
selves are  filled  with  a  liquid  exudate  containing  large  numbers  of 
leucocytes,  red  blood-corpuscles,  and  multinuclear  cells  of  epithelial 
origin.  A  similar  exudate  is  found  in  the  interlobular  spaces,  which 
are  thickened,  infiltrated,  and  cedematous. 

During  the  hepatisation  stage  the  portion  of  lung  affected  is  more 
markedly  swollen  and  no  longer  crepitant  ;  its  colour  is  deeper  ;  its 
density  and  compactness  are  increased,  causing  it  to  resemble  liver, 
and  its  tissue  has  become  friable,  so  that  it  breaks  down  readily  under 
the  pressure  of  the  thumb,  forming  a  reddish  pulp.  Fragments 
removed  from  the  hepatised  mass,  and  dropped  into  water,  slowly  sink 
to  the  bottom.  Sections  are  dark  reddish-brown  or  blackish  in 
colour,  but  on  close  examination  this  coloration  is  seen  to  be  irre- 
gular ;  from  the  dark  ground  formed  by  the  inflamed  pulmonary  tissue 
numerous  little  greyish-white    rounded    points  stand   out,   as  though 


SIMPLE    PNEUMONIA    IN    THE    HORSE.  179 

"set"  in  the  tissue,  indicating  small  masses  of  exudate  which  have 
been  poured  into  the  pulmonary  alveoli,  where  they  have  coagulated 
and  become  adherent  to  the  walls  of  the  air  vesicles.  Sections  are 
less  smooth  than  at  the  former  period  ;  they  have  a  granular  appear- 
ance due  to  projection  above  the  general  surface  of  fibrinous  coagula. 
Moreover  they  no  longer  transude  liquid,  but  on  scraping  yield  small 
quantities  of  blood-stained  serosity,  holding  in  suspension  small 
opaque  whitish  granules.  One  might  be  led  to  regard  these  modifica- 
tions in  appearance  of  the  pulmonary  tissue  as  indicating  complete 
disorganisation,  but  such  is  not  the  case.  Microscopic  examination 
shows  the  following  condition  : — The  air-cells  are  plugged  by  fibrous 
clots  containing  leucocytes,  red  blood-corpuscles,  epithelial  cells,  and 
large  migratory  cells,  exhibiting  highly  refractile  granules ;  in  many 
cases  the  epithelium  is  partly  preserved ;  many  capillaries  are  oblite- 
rated, but  the  alveolar  ducts,  though  thickened  and  infiltrated,  are 
seldom  much  injured. 

In  human  pneumonia,  pneumococci  are  almost  invariably  found  in 
the  affected  area,  whatever  the  stage  of  the  disease.  The  lesions  of 
simple  lobar  pneumonia  in  the  horse  contain  various  microbes,  the 
pathogenic  action  of  which  has  yet  to  be  demonstrated. 

When  resolution  occurs,  the  exudate  contained  in  the  air-cells  is 
freed,  detached,  and  liquefied  ;  the  resulting  material,  which  is  got  rid 
of  through  the  bronchi,  forms  the  discharge  seen  at  this  stage ;  the 
hypera^mia  disappears,  the  alveolar  ducts  regain  their  normal  cha- 
racter ;  the  liquid  which  filtered  into  them  becomes  reabsorbed ;  the 
epithelium  is  restored  at  the  points  where  it  had  been  lost,  and  the 
lung  soon  regains  its  function  in  an  almost  perfect  degree. 

The  post-inoytcin  examination  of  patients  dead  of  pneumonia  some- 
times reveals  generalised  pulmonary  congestion,  pleurisy,  or  myo- 
carditis, sometimes  purulent  or  gangrenous  centres  in  the  hepatised 
tissue. 

Pulmonary  suppuration  assumes  several  forms ;  in  certain  cases 
small  abscesses  are  found  scattered  throughout  a  mass  of  hepatised 
tissue  ;  in  others  there  are  present  one  or  more  large  abscesses,  which 
usually  communicate  with  large  bronchi.  The  contained  pus  is 
whitish,  creamy,  and  odourless,  or  reddish  in  colour,  resembling  wine 
lees,  and  offensive. 

Gangrene  is  oftenest  represented  by  little  greyish-yellow  tracts 
scattered  through  the  hepatised  part.  Sometimes  it  is  "  massive," 
and  affects  a  large  portion  of  the  diseased  lobe ;  it  may  assume  various 
appearances,  the  dead  tissue  being  soft,  blackish,  violet,  greenish  grey, 
or  reduced   to  the  condition  of  a  granular  mass.     Tiie  periphery  of 


i8o  CLINICAL  vetp:rinarv  medicine  and  surgery. 

these  gangrenous  patches  is  not  usually  well  defined,  but  shades  off 
into  the  adjacent  hepatised  tissue,  which  is  gradually  invaded  by  the 
necrotic  process. 

During  the  course  of  the  disease  the  bronchial  lymphatic  glands 
become  swollen,  but  never  of  great  size. 

The  diagnosis  of  pneumonia  is  eas}-.  The  veterinary  surgeon  is 
seldom  called  in  until  the  second  or  third  day  after  the  onset.  The 
somnolence,  depression,  rapid,  painful,  and  often  moaning  respiration, 
and  the  yellowish  colour  of  the  conjunctiva  are  all  significant.  In 
many  cases  pneumonia  can  be  surmised  after  examination  of  the  con- 
junctiva and  a  glance  at  the  flank.  With  a  little  practice  in  clinical 
observation  one  is  rarely  mistaken.  The  rusty  discharge,  when  present, 
is  pathognomonic.  Auscultation  and  percussion  indicate  the  position 
and  extent  of  the  inflamed  area. 

In  bronchitis  the  cough  is  strong  and  paroxysmal,  the  discharge 
muco-purulent,  the  respiration  less  frequent,  and  the  fever  less  active. 
From  the  point  of  view  of  their  relative  frequence  pleurisy  is  rare  as 
compared  with  pneumonia ;  and  you  know,  furthermore,  that  differen- 
tial symptoms  exist.  As  to  acute  primary  endocarditis,  you  may 
possibly  never  meet  with  it. 

Provided  the  ordinary  course  and  characters  of  pneumonia  are 
known,  complications  should  early  be  detected.  In  a  patient  in  which 
resolution  was  deferred  beyond  the  ninth  day  I  discovered  secondary 
pleurisy,  the  onl}-  case  which  I  have  seen  during  the  course  of  the 
present  year. 

The  prognosis  of  simple  pneumonia  is  serious,  on  account  of  the 
functional  importance  of  the  affected  organ  ;  but  except  in  the  cases  of 
old,  feeble,  and  emphysematous  patients,  and  those  suffering  from 
cardiac  disease,  pneumonia  only  proves  fatal  when  followed  by  com- 
plications, such  as  diffuse  congestion  of  both  lungs,  oedema,  suppura- 
tion, gangrene  of  the  lung,  or  inflammation  of  the  heart  muscle. 

Careful  treatment  usually  pre\'ents  such  accidents.  The  mortality  of 
uncomplicated  cases  is  scarcel}'  5  per  cent. 

When  simple  inflammation  of  the  lung  de\'elops  regularl}'  and  is 
unattended  with  complications  it  tends  towards  resolution.  Prompti- 
tude in  treatment  is  very  important.  If  the  disease  is  not  recognised 
at  the  beginning  it  ma}-  become  greatl}'  aggra\-ated  b}-  work. 

The  animal  is  isolated  in  an  airy  box,  which  should  be  kept  at  a 
moderate  and  regular  temperature,  and  is  kept  warm  b}'  abundant 
clothing.     If  appetite  is  retained,  mashes,  barle}-  or  oatmeal  gruel,  hay 


SIMPLE    PNEUMONIA    IN    THE    HORSE. 


tea,  etc.,  may  be  given.  The  patient  should  have  constant  access  to 
chilled  water  or  gruel  ;  perfectly  cold  water  is  sometimes  injurious.  If 
it  eats  little,  and  will  not  touch  ordinary  food,  milk  may  be  prescribed. 
Most  horses  take  milk  readily  to  the  extent  of  six,  eight,  or  ten  quarts  per 
day.  Some,  however,  refuse  it,  and  will  not  swallow  even  a  mouthful, 
appearing  to  have  a  distaste  for  it  ;  but,  after  a  little  patience,  end  by 
taking  it  well.  The  attendant  should  hold  the  animal's  head,  bring 
the  bucket  containing  the  milk  near  its  mouth,  and  introduce  a  little 
by  means  of  the  hand.  This  may  be  repeated  several  times,  and  the 
milk  then  be  offered  in  the  bucket.  If  the  horse  will  only  swallow  a 
little  he  very  often  ends  by  emptying  the  bucket  at  a  draught,  and 
afterwards  makes  no  difficulty  about  taking  it.  To  starve  cases  of 
pneumonia  (as  is  still  done  by  many  practitioners)  is  a  mistake.  They 
should,  on  the  contrary,  be  carefully  fed  and  their  strength  sustained 
with  such  foods  as  they  seem  most  to  like. 

A  first  case  of  pneumonia  should  not  necessarily  be  regarded  as 
sporadic,  to  the  exclusion  of  prophylactic  measures.  It  is  always  better 
to  isolate  the  animal,  especially  if  other  young  horses  are  in  the  same 
stable. 

I  do  not  recognise  any  specific  treatment  of  pneumonia.  The 
management  of  the  case  varies  according  to  the  animal's  constitution, 
the  intensity  and  stage  of  the  disease,  the  degree  of  fever,  and  the 
predominance  of  particular  symptoms. 

Bleeding,  again  revived  at  the  present  day  in  the  treatment  of 
pneumonia  in  man,  has  never  been  entirely  abandoned  in  veterinary 
practice.  It  may  prove  of  real  service  by  its  double  mechanical  and 
chemical  action.  During  the  hepatisation  stage  of  pneumonia  especially 
the  greatest  danger  is  often  to  be  found  in  the  condition  of  the  heart. 
In  consequence  of  the  obliteration  of  vessels  in  the  hepatised  area  the 
right  heart  finds  its  work  greatly  increased ;  it  may  falter,  and  even 
succumb.  The  removal  of  three  to  six  quarts  of  blood,  depending  on 
the  animal's  weight,  diminishes  the  circulatory  disturbance  and  assists 
the  heart,  which  beats  more  easily.  In  addition  to  this  purely 
mechanical  effect  bleeding  has  two  others,  not  less  valuable.  In 
patients  in  which  the  blood  is  greatly  vitiated  by  the  presence  of 
microbic  poisons,  bleeding  before  the  crisis  removes  from  the  circulation 
a  notable  amount  of  these  poisons,  at  the  same  time  increasing  the 
bactericidal  power  of  the  serum  ;  and  if  supplemented  by  injection  of  the 
chemical  solutions  of  which  I  shall  shortly  speak,  this  antitoxic  action 
is  favoured.  Furthermore  it  is  proved  that  bleeding  increases  oxida- 
tion processes,  and  thus  assists  in  eliminating  poisons  from  the  blood 
and   tissues.      But  to   pretend  that   removal   of  blood   can  check   the 


1 82  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

infectious  process  itself  is  e\'idently  an  exaggeration.  It  never  arrests 
the  course  of  pneumonia,  and  I  regard  it  as  simpl)-  shortening  its 
duration. 

Counter-irritants  ahnost  alwa}-s  give  reHef,  especially  when  early 
resorted  to.  Mustard  is  perhaps  the  best,  and  is  applied  in  the  form 
of  a  plaster  to  the  sides  and  under  parts  of  the  chest.  It  may  also  be 
used  for  rubbing  the  limbs  ;  but  it  is  ill-judged  to  extend  its  application 
excessivel}'.  The  plaster  is  left  in  position  for  several  hours.  The 
essential  oil  which  it  gives  off  produces  smart  irritation  of  the  skin, 
and  abundant  infiltration  into  the  subcutaneous  connective  tissue. 
During  the  hours  succeeding  its  use  the  patient  is  less  depressed,  the 
breathing  and  circulation  are  markedly  relieved,  and  there  is  often 
temporary  diminution  in  the  fever.  Counter-irritation  also  renders 
phagocytosis  more  active.  Essential  oil  of  mustard  applied  with 
friction  has  the  same  effects  as  a  plaster.  In  grave  cases  of  pneu- 
monia, where  the  hepatisation  stage  is  abnormall}^  prolonged  or 
marked  by  serious  heart  symptoms,  many  practitioners  use  blisters. 
Not  only  is  the  effect  of  blisters  mediocre  and  doubtful,  but  they  have 
the  disadvantage  of  rendering  the  patient  uneasy,  and  of  preventing  the 
practitioner  afterwards  following  the  course  of  the  disease  by  ausculta- 
tion, etc.  The}-  often  blemish,  and  are  not  without  other  grave  draw- 
backs. In  some  cases  absorption  occurs,  producing  irritation  of  the 
kidneys. 

The  value  of  "issues"  has  also  been  exaggerated,  and  they  are 
much  less  used  than  formerly,  being  now  practically  confined  to  the 
region  of  the  chest.  They  produce  acute  suppurative  inflammation 
around  the  points  of  insertion  ;  similar  results  follow  the  subcutaneous 
injection  of  oil  of  turpentine,  or  of  any  irritant  liquid.  Such  means  of 
treatment,  however,  may  even  facilitate  infection.  Some  practitioners 
claim  to  draw  valuable  conclusions  from  their  action  ;  if  suppuration  is 
free,  the  pneumonia  is  taking  a  favourable  course ;  but  failure  in  this 
respect  alwaj^s  constitutes  an  unfavourable  sign. 

As  in  other  infectious  diseases,  saline  or  alkaline  solutions  have  an 
excellent  effect.  The  resistance  of  the  organism  to  infection  is  propor- 
tionate to  the  degree  of  alkalinity  of  the  blood,  but  as  this  alkalinity 
tends  to  diminish  I  often  utilise  subcutaneous  injections  of  different 
chemical  solutions,  particularly  of  7  to  '8  per  cent,  salt  solution  in  daily 
doses  of  six  to  fifteen  fluid  ounces.  These  salines  affect  the  blood- 
})lasma,  rendering  it  more  alkaline  and  increasing  its  bactericidal 
properties,  at  the  same  time  stimulating  secretion  and  the  elimination 
of  toxins.  Alkalinity  of  the  blood  may  also  be  favoured  by  the  adminis- 
tration of  daily  doses  of  one  and  a  half  to  three  ounces  of  bicarbonate 


SIMPLE    PNKUMONIA    IN    THE    HORSE.  1 83 

of  soda,  given  in  the  drinking-water.     Its  effects  are  excellent  at  all 
stages  of  the  disease. 

Antimonial  preparations — tartar  emetic  and  sulphide  of  antimony 
— adopted  from  human  medicine,  have  similar  antiphlogistic  effects  to 
bleeding,  though  they  act  in  a  different  manner,  Tartar  emetic  is 
given  in  doses  of  one  and  a  half  to  three  drachms  per  day  in  the  food. 
It  renders  the  breathing  easier,  and  slows  the  circulation,  but  in  general 
its  therapeutic  value  has  been  greatly  over-estimated. 

Dilute  alcohol  in  the  form  of  brandy,  whisky,  rum,  or  wine  is  much 
used,  and  not  without  benefit.  It  checks  excessive  tissue  metabolism, 
supports  the  animal's  powers,  acts  as  a  tonic,  tends  to  lower  tempera- 
ture, and  has  the  advantage  of  being  readily  taken  in  the  drinking- 
water  or  in  electuary.  I  frequently  prescribe  four  to  eight  iluid  ounces 
of  brandy  per  day.  It  can  be  given  from  the  commencement  and  con- 
tinued until  resolution  begins,  the  dose  being  varied  according  to  the 
symptoms. 

Digitalis  is  of  unquestionable  value,  especially  when  the  heart 
muscle  shows  signs  of  exhaustion,  as  indicated  by  rapidity  and  feeble- 
ness of  the  pulse.  It  is  given  in  doses  of  three  quarters  to  one  and  a 
half  drachms  in  electuary,  and  continued  for  several  days.  In  many 
cases  change  in  the  heart's  action  and  the  condition  of  the  vessels 
follows  in  a  few  hours,  the  heart  beats  becoming  less  powerful  and 
sudden,  and  the  pulse  stronger  and  more  regular.  Doses  of  two  to 
three  drachms,  given  by  some  practitioners,  are  excessive.  When  long 
continued,  digitalis  produces  change  in  the  heart  fibres,  which  appear 
to  undergo  fatty  degeneration. 

Iodide  of  potassium  has  been  given  at  all  stages  of  the  disease  in 
doses  of  one  and  a  half  to  three  drachms  per  day.  Various  good  effects 
are  attributed  to  it,  such  as  those  of  moderating  the  circulation  and 
respiration  and  of  lowering  temperature.  Its  value,  however,  is  slight 
except  during  the  period  of  resolution,  when  it  favours  absorption  of 
newly  formed  tissue  in  the  bronchial  glands,  and  thus  prevents  com- 
pression and  atrophy  of  the  left  recurrent  nerve,  one  of  the  causes  of 
chronic  roaring. 

Salicylate  of  soda  may  prove  of  value  in  lowering  temperature, 
while  as  a  general  antiseptic  it  is  preferable  to  salicylic  acid,  which 
irritates  the  gastro-intestinal  mucous  membrane.  It  has  been  strongly 
recommended  during  the  period  of  resolution  in  order  to  prevent  the 
attacks  of  SNUovitis  seen  during  or  after  pneumonia. 

Quinine  salts,  like  the  sulphate  and  hydrobromate,  have  recently 
been  used  by  many  practitioners.  They  temporarily  lower  temperature 
and  slow  the  circulation,  thus  exercising  an  antifebrile  and  tonic  effect. 


t84  clinical    VKTERINAKY    .MEDICINE    AND    SURGERY. 

They  are  also  recommended  where  suppuration  or  gangrene  is  feared, 
and  can  be  given  in  electuary  in  daily  doses  of  one  and  a  half  to  four 
drachms. 

Sulphate  of  soda  in  doses  of  three  to  six  ounces  stimulates  the 
intestinal  secretion  and  favours  free  circulation  of  digested  material. 
During  the  early  febrile  and  hepatisation  periods  it  is  given  like  the 
bicarbonate  in  drinking-water  or  mashes. 

Cold  enemas  to  diminish  constipation  and  fever,  nourishing  enemas 
to  sustain  the  bodily  strength  when  ordinary  food  is  refused,  and  anti- 
septic enemas  to  prevent  or  limit  suppuration  or  pulmonary  gangrene, 
are  also  measures  deserving  of  attention. 

Suppuration  and  pulmonary  gangrene,  as  I  have  said,  almost  always 
prove  fatal.  An  abscess  formed  in  the  midst  of  pulmonary  tissue  may 
under  exceptional  circumstances  open  into  a  bronchus,  its  contents 
become  evacuated  and  its  walls  cicatrised  :  a  gangrenous  fragment  may 
similarly  be  got  rid  of  or  may  become  encysted,  the  patient  in  either 
case  surviving ;  but  such  endings  are  rare,  and  treatment  is  of  little 
value.  The  patient's  strength  must  be  supported  by  milk,  hay  tea, 
and  fluid  nourishment  to  which  has  been  added  alcohol.  Antiseptics 
are  employed  in  the  form  of  fumigations,  intra-tracheal,  subcutaneous, 
or  intra-venous  injections.  Solutions  of  iodine  or  carbolic  acid  are 
often  administered  by  the  last  method.  Direct  injection  of  antiseptics 
into  the  gangrenous  centres  has  been  little  used  in  the  horse,  and  on 
the  several  occasions  I  have  performed  it  the  result  was  unsatisfactory. 
Puncture  of  a  purulent  or  gangrenous  centre  through  the  thoracic  wall, 
followed  by  evacuation  of  the  contents  and  drainage  of  the  cavity,  has 
been  attempted  as  a  last  resource  where  the  diseased  lung  was  adherent 
to  the  wall  of  the  chest. 


XXVIL— PNEUMONIA    IN    THE    HORSE    (CONCLUSION). 

In  equine  pathology  the  name  of  Contagious  Pneumonia  is  given 
to  a  form  of  inflammation  of  the  lung  which  was  long  confused 
with  simple  pneumonia,  and  with  the  abdominal  form  of  influenza. 
More  than  half  a  century  ago  the  horse  was  known  to  suffer  from  an 
inflammatory  lung  disease,  which  simultaneously  affected  numbers  of 
animals,  and  differed  in  its  course  from  pneumonia  a  frigove.  It  was 
described  under  the  titles  bilious  pneumonia,  adynamic  or  ataxic 
pneumonia,  and  stable  pneumonia. 

Veterinary  journals  contain  reports  regarding  this  affection,  which 
are  now  more  or  less  ancient  history.  The  cases  related  are  always 
referred  to  simple  causes,  especially  to  the  action  of  cold  on  a  number 
of  patients  placed  under  similar  conditions  of  hygiene,  feeding,  and 
work. 

The  views  at  present  held  in  regard  to  contagious  pneumonia  are 
founded  on  clinical  observation  and  laboratory  work,  and  only  date 
back  about  ten  years.  In  France,  Cagnat,  of  St.  Denis,  published 
in  the  Archives  vctcrinaircs  for  1884,  the  hrst  cases  clearly  establish- 
ing the  occurrence  of  contagious  pulmonary  inflammation  in  the  horse. 
Some  years" "later  Messrs.  Benjamin  and  Brun  adduced  others.  About 
the  same  time  Siedamgrotzky  and  Dieckerhoff  in  Germany  published 
essays  on  this  affection,  each  observer  regarding  it  from  his  own  par- 
ticular standpoint.  In  1887  Schutz  isolated  and  cultivated  a  micro- 
organism, which  he  considered  the  specific  agent.  Since  then  investi- 
gations have  become  very  numerous.  MM.  Chantemesse  and  Delamotte, 
Galtier  and  Violet,  have  found  in  the  lesions  two  microbes,  which  they 
considered  different  from  that  isolated  by  Schutz.  MM.  Cadeac  and 
Leclainche  have  written  good  monographs  on  the  subject.  M.  Trasbot, 
who  described  the  disease  in  his  lectures  under  the  name  of  "  Stable 
Pneumonia,"  penned  a  learned  article  on  it  in  the  eighteenth  volume  of 
the  Didionnaire  pratique  de  Medecine  et  de  Chirurgie  veterinaire.      Finally, 


l86  CLINICAL    VP:TKRINAKV    iMKDlCINK    AND    SUK(;ERV. 

we  owe  the  histor}-  of  several  carefull}'  studied   epidemics  to  certain  of 
our  militar}-  colleagues. 

Contagious  pleuro-pneumonia  of  the  horse  results  from  the  entrance 
into  and  development  within  the  organism  of  a  specific  pathogenic 
microbe.  Sometimes  the  animal  is  infected  by  contact  with  a  diseased 
subject,  at  others  infection  is  mediate.  The  disease  is  most  commonly 
seen  in  large  stables  where  the  work  necessitates  frequent  renewals  of 
stock.  One  of  the  new-comers  is  first  affected  ;  a  week  to  fourteen 
days  later  a  second  shows  s}'mptoms,  and  the  disease  successively 
attacks  a  number  of  animals,  comprising  one  third,  one  half,  or  two 
thirds  of  the  whole  number,  sometimes  even  more — in  one  of  Cagnat's. 
series  tw^elve  out  of  fifteen,  and  in  some  I  have  myself  seen,  seven  out 
of  nine. 

The  stables  of  horse  dealers,  omnibus  companies,  remount  depots,, 
cavalry  quarters,  and  veterinary  infirmaries,  are  most  commonly 
invaded.  Once  introduced  the  disease  ma}-  continue  for  a  long  time 
in  an  enzootic  form,  diminishing  and  again  re\iving,  the  revivals  almost 
always  following  the  introduction  of  freshly  bought  horses. 

It  attacks  young,  adult,  and  old  animals,  though  certain  ages  are 
more  subject  than  others.  Horses  between  four  to  eight  years  old, 
especially  if  recently  brought  into  work,  are  those  most  commonly 
affected  ;  aged  animals  are  less  subject.  If  during  an  outbreak  of  this 
form  of  pneumonia  it  becomes  necessar}'  to  introduce  fresh  horses,  aged 
animals  should  always  be  gi\en  the  preference,  30ung  horses  almost 
invariably  becoming  infected. 

In  stables  where  the  disease  was  raging  I  have  often  noticed  that 
horses  which  had  previously  suffered  from  an  attack  remained  quite 
unaffected.  Many  other  practitioners  have  made  the  same  observation. 
An  attack  undoubtedly  confers  immunity  for  a  certain  period,  some- 
times during  the  animal's  whole  life ;  though  in  most  instances  this 
immunity  diminishes  and  may  entirel}'  disappear  with  lapse  of  time. 
Instances  of  recurrence,  adduced  in  opposition  to  this  idea,  in  no  wise 
weaken  it,  being  readily  explained  by  the  man}-  forms  assumed  by 
pneumonia,  and  by  the  gradual  loss  of  acquired  immunity. 

Generally  speaking,  then,  experience  shows  that  one  attack  renders 
the  subject  refractor}-  or  little  susceptible  to  a  second.  Cagnat  well 
understood  this,  and  with  the  courage  of  his  con\-ictions  even  went  so 
far  as  to  recommend  that  when  purchasing  preference  should  be  given 
to  horses  whose  chtsts  showed  traces  of  the  counter-irritants  applied 
during  a  previous  attack  of  pneumonia.  That  is  to  say,  he  recom- 
mended exactl}'  the  contrary  of  what  is  usuall}-  practised. 


CONTAGIOUS    PNEUMONIA.  1 87 

In  comparing  contagious  pneumonia  and  the  abdominal  form  of  in- 
fluenza  from  the  point  of  view  of  the  subtlety  of  infection  and  rapidity 
of  extension  marked  differences,  however,  are  apparent.  As  Fried- 
berger  and  Frohner  remark,  the  diffusion  of  the  specific  agent  is 
usually  slower  in  the  former  case,  and  its  method  of  propagation 
different.  Although  in  certain  outbreaks  among  army  horses  con- 
tagious pneumonia  affected  ten,  twenty,  or  thirty  subjects  within  a 
few  days,  the  occurrence  is  exxeptional ;  whilst  in  the  same  period  the 
abdominal  form  of  influenza  might  have  attacked  hundreds  of  animals. 
Another  difference  noted  by  the  same  authors,  confirmed  by  many 
practitioners,  and  again  recently  mentioned  by  M.  Laporte,  has 
reference  to  the  mode  in  which  the  infection  spreads.  Contagious 
pneumonia  attacks  irregularly,  often  affecting  animals  far  removed 
from  the  first  case,  while  influenza  is  more  frequently  transmitted 
from  one  case  to  another,  following  a  fairly  regular  line. 

Direct  transmission  is  the  rarest  method  of  contagion.  The  disease 
is  generally  spread  bj-  intermediate  channels,  such  as  the  air,  forage, 
manure,  pails,  or  mangers,  or  even  by  attendants,  grooms,  owners,  or 
veterinary  surgeons.  In  one  instance  the  disease  was  communicated 
to  a  mare,  isolated  far  from  the  infected  stable  in  a  special  place,  by 
means  of  a  mash  taken  from  the  manger  of  a  horse  suffering  from 
pneumonia.  In  order  to  prevent  it  being  "wasted"  the  groom  had 
given  this  mare  the  bran  left  by  the  patient. 

Many  veterinary  surgeons  have  seen  enzootics  of  contagious  pneu- 
monia in  stables  without  infection  having  been  introduced  by  recently 
bought  animals,  and  in  towns  or  parts  of  the  country  where  the  disease 
did  not  previously  exist.  In  these  cases  the  locality  and  especially  the 
soil  have  been  blamed.  In  all  probability  the  infectious  organisms 
had  been  in  existence,  but  had  long  remained  dormant  or  continued 
growing  as  saprophytes,  and  afterwards,  under  the  influence  of  un- 
determined conditions,  recovered  their  virulence  and  primar}-  activity, 
causing  an  outbreak  of  disease. 

The  contagious  material  enters  by  the  respiratory  passages  sus- 
pended in  the  inspired  air,  or  by  the  digestive  mucous  membrane  along 
with  food  or  drink.  Schiitz  declared  the  specific  agent  to  consist  of 
a  little  ovoid  bacterium  generally  arranged  in  twos,  the  biological 
characters  of  which  he  described.  Though  pathogenic  in  the  horse^ 
rabbit,  guinea-pig,  mouse,  and  pigeon,  it  is  without  action  on  the  pig 
and  fowl.  Inoculation  of  a  culture  of  this  microbe  into  the  horse 
reproduces  the  disease.  If  introduced  into  the  parenchyma  of  the  lung 
by  transfixing  the  wall  of  the  chest  and  the  pleura  with  an  antiseptic 
needle  or  trocar,  the  symptoms  of  contagious  pneumonia  appeared  in 


I«5  CLINICAL    VKTERINARY    MEDICINK    AND    SURCERY. 

a  few  hours,  developing  in  the  usual  way  and  producing  necrotic 
lesions  in  the  lung  and  degenerative  changes  in  the  viscera.  In  con- 
tradistinction to  the  pneumococcus  of  man,  which  is  delicate  and 
ephemeral,  and  sometimes  disappears  from  the  lesions  after  a  very  few 
days,  the  bacteria  in  question  show  considerable  resistance  to  destruc- 
tive influences.  In  patients  which  survive  they  may  long  preserve  their 
vitality,  multiplying  in  the  necrotic  centres  surrounded  by  a  zone  of 
fibrous  tissue,  and  when  these  centres  are  in  communication  with  the 
bronchi  being  continually  discharged,  and  rendering  the  nasal  dis- 
charge virulent  for  months.  Convalescent  or  apparently  cured  cases 
in  which  the  lung  contains  such  centres  long  remain  dangerous.  They 
perpetuate  the  disease  in  certain  stables,  or  introduce  it  into  other 
previously  healthy  quarters,  where  the  first  cases  are  naturally  referred 
to  the  action  of  atmospheric  changes. 

Though  admitted  by  some  authors,  the  specific  character  of  this 
microbe  and  the  powers  attributed  to  it  by  Schiitz  have  been  contested 
by  others,  especially  by  Hell  and  Baumgarten.  In  i8go  Hell  under- 
took certain  researches  consisting  in  cultivating,  staining,  and  inocu- 
lating with  the  organism,  in  order  to  determine  the  analogies  and 
differences  which  existed  between  it  and  the  several  streptococci.  From 
them  he  concluded  that  by  the  bacteriological  methods  then  in  use  no 
clearly  marked  difference  could  be  established  between  the  microbe  in 
question  on  the  one  hand,  and  the  Streptococcus  pyogenes  of  the  horse 
and  the  streptococcus  of  erysipelas  in  man  on  the  other ;  and  further- 
more, that  these  species  are  similar  from  the  morphological  and 
biological  points  of  view,  and  from  the  manner  in  which  they  behave 
when  inoculated.* 

'■'  Recent  researches  by  W.  Lignieres  seem  to  show  that  the  microbe  described  by 
Schiitz  is  the  streptococcus  of  strangles,  and  that  it  only  plays  a  secondary  part  in  the 
aetiology  of  pneumonia  in  the  horse.  It  is  generally,  but  not  always,  found  in  the  lungs  of 
horses  dead  of  pneumonia.  The  true  microbe  of  pneumonia  is  said  to  be  the  "  cocco-bacille 
typhiqiie^'  of  the  order  Pasteiirella.'  This  micro-organism,  which  >grows  as  a  saprophyte  in 
forage,  manure,  water,  and  soil,  and  becomes  pathogenic  under  the  influence  of  causes  at 
present  unknown,  appears  as  a  monococcus,  diplococcus,  or  as  a  little  bacillus  with  rounded 
extremities.  The  last  is  the  "true"  form  of  the  microbe  ;  at  the  moment  when  it  divides  it 
appears  as  a  diplococcus.  The  monococci  result  from  complete  and  recent  separation  of 
the  diplococci.  Finally,  under  certain  conditions  these  microbes  take  the  form  of  "  strepto- 
cocco-bacilUy  The  organism  is  aerobic,  produces  no  spores,  and  is  killed  in  less  than  a 
quarter  of  an  hour  by  a  temperature  of  65"^  C,  but  grows  freely  in  peptonised  bouillon  and 
on  gelatine  at  20°  C.  It  is  pathogenic  for  the  guinea-pig,  rabbit,  and  horse,  and  rapidly  kills 
these  animals  on  subcutineous  inoculation.  M.  Lignieres  has  found  it  in  cases  of  pleurisy, 
infectious  pleuro-pneumonia,  in  broncho-pneumonia,  and  in  infectious  sore  throat,  in 
pneumonia  a  frigore,  in  the  abdominal  form  of  influenza,  in  the  pneumonia  of  strangles,  and  in 
"  stable  pneumonia."     All  these  affections  are  said  to  be  but  varieties  of  " Pasteurellosis." 

Infectious    pneumonia   is   due    to   the   "  hacillc    typhiqur"  which    is  able   to   multiply  in 


CONTAClIOrS    PNKUMONIA.  1 89 

The  symptoms  of  contagious  pneumonia  are  by  no  means  so 
constant  or  so  uniform  as  has  been  suggested  by  certain  authors. 
Among  those  regarded  as  most  important  some  are  susceptible  of 
modifications  in  their  expression  and  intensity,  which  are  apt  to  deceive 
the  practitioner  who  only  looks  for  typical  cases.  As  in  the  simple 
form,  three  periods  may  be  distinguished  :  (i)  onset  and  increase  ;  (2) 
hepatisation  ;  and  (3)  resolution,  gangrene  or  suppuration. 

The  onset  is  usual!}-  sudden,  and  too  well  marked  to  be  overlooked. 
A  few  patients  remain  fairly  bright  and  livel}',  and  continue  to  take  part 
of  their  food  ;  but  the  majority  are  dull  and  depressed,  hang  back  from 
the  manger,  and  do  not  touch  anything.  The}-  show  rigors,  trembling 
fits,  and  signs  of  sore  throat,  bronchitis,  or  slight  colic.  In  the  play  of 
symptoms  now  commencing  two  signs,  however,  o\-ershadow  all  others, 
the  acceleration  of  breathing  and  the  fe\er.  With  rare  exceptions  the 
flank  mo\'ement  is  already  \-ery  rapid,  and  attracts  attention.  The 
respirations  are  from  20  to  30  per  minute  ;  sometimes  inspiration  is 
fairly  free,  sometimes  \-er}-  shallow.  The  temperature  rapidl}-  rises  to 
a  high  point,  often  marking  40°,  40*5'^,  or  even  41'^  C.  (104'^  F.  to 
105*8°  F.),  before  the  animals  are  noticed  to  be  ill.  I  twice  noted  the 
latter  figure  on  first  examining  animals  which  onl}-  the  e^■ening  before 
had  appeared  health}-  both  in  regard  to  work  and  feeding.  Where 
patients  ha%-e  been  observed  from  the  outset  the  temperature  has  often 
risen  3°  C.  in  twent}'-four  hours. 

The  conjuncti\-a  is  usuall\-  reddish,  sometimes  of  a  yellowish  tint,  the 

the  lung  rhieflv  in  consequenre  of  being  associated  with  the  streptococcus  of  strangles. 
At  the  moment  when  the  "  bacille  typhiqiie"  affects  the  organism,  the  streptococcus  of 
strangles  (which  is  widely  distributed)  is  often  to  be  found  in  the  upper  air-passages, 
without,  however,  having  produced  any  manifest  indications  of  its  existence.  Thanks  to 
the  depression  of  the  svstem  produced  by  the  "  cocco-bacille,'"  the  streptococcus  multiplies 
in  the  lungs,  forms  caseous  centres  around  the  bronchi,  and  then  gradually  invades  the  paren- 
chyma of  the  lung  and  more  or  less  completely  the  entire  organism. 

Inoculation  of  healthy  animals  with  attenuated  "  bacilles  typhjijiies"  should  render  them 
proof  not  only  against  the  abdominal  form  of  influenza,  but  also  against  pneumonia  of  the 
same  character.  Hence  the  use  of  vaccination  as  a  prophylactic  measure  in  affected  stables. 
Sick  horses  should  be  simultaneously  treated  with  injections  of  protective  strangles  serum 
and  of  "serum  antityphiqiier 

Experience  has  not  yet  pronounced  on  these  laboratory  suggestions.  The  first  test,  of 
the  protective  method  with  the  vaccine  of  "  Pasteurellose  equine,"  however,  was  made  in  the 
stables  of  the  Compagnie  Generale  des  Voitures  de  Paris.     The  result  was  as  follows  : 

"  From  the  4th  October,  1897,  to  the  12th  May,  1898,  5007  horses  were  bought.  All  the 
odd  numbers  were  twice  vaccinated,  whilst  the  even  numbers  were  left  as  controls.  Up  to 
the  31st  October,  1898,  two  hundred  and  fifty-four  horses  had  died  from  chest  diseases,  one 
hundred  and  fifty-eight  which  had  not  been  vaccinated, — that  is  to  say,  a  loss  of  601  per 
cent.;  and  ninety-six  which  had  been  twice  vaccinated,  that  is  a  loss  of  403  per  cent.  Seven, 
horses  were  killed  bv  the  use  of  insufficientlv  attenuated  vaccine." 


190  CLINICAL    VETERINARY    MEDICINE    AND    SURC;ERY. 

mucous  membrane  of  the  mouth  warm,  the  tongue  coated,  the  ears  and 
extremities  are  cold.  Movement  appears  painful,  and  the  patient  is 
sometimes  unsteady  on  its  legs.  In  most  the  cough  is  deep, 
paroxysmal,  and  accompanied  by  discharge  of  a  little  greyish  or  rusty 
mucus,  which  may  be  streaked  with  blood.  In  some  there  is  slight 
haemorrhage  from  both  nostrils,  a  symptom  which  may  recur  several 
times  during  the  course  of  the  disease. 

Auscultation  and  percussion  of  the  lung  seldom  reveal  any  modifi- 
cation in  the  pulmonary  sounds  or  pulmonary  resonance.  The  earlv 
lesions  appear  to  affect  the  deeper  seated  portions  of  the  lung  around 
the  bronchi,  the  superficial  layers  of  the  affected  lung  remaining 
unchanged,  so  that  percussion  and  auscultation  are  only  useful  at 
a  later  stage.  You  have  seen  this  in  many  of  our  patients.  Excep- 
tions, how^ever,  occur.  In  some  animals  various  stethoscopic  signs 
like  disappearance  of  the  vesicular  murmur,  or  the  existence  of  crepi- 
tation, may  be  noted  soon  after  appearance  of  the  first  symptoms.  In 
one  case  we  heard  the  tubal  murmur  on  the  right  side  after  the  third 
day,  the  percussion  sound  over  the  corresponding  lower  half  of  the 
thorax  being  simultaneously  dull. .  It  must  be  remembered  that  cases 
of  this  nature — in  which  the  auscultation  and  percussion  signs  resemble 
those  of  simple  pneumonia — are  somewhat  frequent,  because,  as  in  that 
disease,  the  pulmonary  lesions  may  be  extensive,  involving  an  entire 
lobe  or  the  whole  thickness  of  the  lung  almost  from  the  first.  Auscul- 
tation over  the  prsecordial  region  reveals  increase  both  in  power  and 
frequency  of  the  heart's  action,  while  the  two  normal  sounds  are 
slightly  accentuated.  The  pulse  is  rapid,  full,  and  strong,  or  may 
already  have  become  distinctly  weak. 

During  the  stage  of  augmentation  the  first  symptoms  become  aggra- 
vated or  variously  modified,  and  others  appear.  The  temperature  often 
exceeds  41°  C.  (i05"8°  F.),  and  shows  daily  oscillations  to  the  extent 
of  one  degree  or  more.  Respiration  remains  very  rapid  and  shallow  ; 
occasionally  it  appears  hesitating.  In  some  patients  auscultation  and 
percussion  still  reveal  no  pulmonary  change.  Crepitation  and  partial 
dulness  usually  occur  on  the  third  or  fourth  day,  murmurs  and  dulness 
twenty-four  or  forty-eight  hours  later.  The  circulation  is  always  rapid  ; 
the  heart  beats  violently,  the  sounds  being  either  normal  or  modified  in 
intensity  and  sometimes  in  rhythm  ;  the  pulse  loses  its  strength  and 
fulness.  The  conjunctiva  is  reddish  yellow  or  icteric ;  sometimes 
hyperaimia  is  more  marked,  and  accompanied  by  slight  infiltration. 
Many  animals  still  take  mashes,  milk  and  a  little  hay  ;  some  pass  dry, 
hard,  coated  faeces  ;  in  almost  all  thirst  is  great  ;  dulness  and  loss  of 
strength  are   more  marked,  the   gait  is  vacillating,  and  the  tail  hangs 


CONTA(;iOUS    PNEUMONIA.  19I 

limp.  Some,  however,  appear  much  less  depressed,  and  in  entire 
horses  erections  occasionally  occur. 

During  the  period  of  hepatisation  most  of  the  preceding  symptoms 
subside.  Respiration,  however,  becomes  more  and  more  rapid,  is 
painful,  difficult,  and  sometimes  moaning;  when  pleurisy  occurs  as  a 
complication,  inspiration  and  expiration  are  separated  by  a  distinct 
pause.  The  cough  and  discharge  usually  disappear.  In  one  of  our 
patients  I  noted  on  three  occasions  discharge  of  blood  from  both 
nostrils,  due  undoubtedly  to  pulmonary  haemorrhage  ;  but  this  is  a  rare 
occurrence.  The  pulse  is  very  rapid,  small  and  feeble,  occasionally 
irregular  or  intermittent ;  sometimes  there  is  a  venous  pulse.  The 
temperature  usually  remains  stationary  except  as  regards  the  afore- 
mentioned daily  oscillations,  but  it  may  rise  to  41*8°  or  even  to  42°  C* 
(io7'2°  F.  to  io7'6°  F.)  ;  sometimes  it  is  very  irregular,  and  shows  varia- 
tions of  1°  to  2°  C.  within  twenty-four  hours.  After  the  fourth  day 
pulmonary  changes  can  usually  be  readily  detected,  though,  as  you  have 
seen  in  one  of  our  cases,  they  may  remain  concealed  until  the  fifth  day. 
Some  months  ago  a  colleague  asked  me  to  examine  one  of  his  horses 
which  had  been  very  ill  for  several  days,  and  which  he  thought  was 
suffering  from  endocarditis.  On  auscultation  I  certainly  detected 
cardiac  disturbance,  but  I  also  noted  absence  of  the  vesicular  murmur 
on  the  right  side,  and  slight  crepitation  at  several  spots.  The  diagnosis 
was  clear.  Next  day  there  was  a  tubal  murmur;  the  pneumonia  had 
been  in  existence  for  six  days. 

Depending  on  whether  pneumonia  is  lobular  or  lobar,  the  signs 
recognised  on  auscultation  and  percussion  differ  very  greatly.  In  the 
lobar  type  the  stethoscopic  sounds  are  those  of  simple  pneumonia ;  in 
the  lobular  the  vesicular  murmur  is  at  several  spots  replaced  by  a 
crepitant  rale  ;  but  if  the  centres  of  lobular  pneumonia  become  con- 
fluent the  signs  noted  are  those  of  extensive  hepatisation,  a  tubal 
murmur  being  heard  with  more  or  less  complete  dulness  in  the  lower 
region  of  one  or  both  sides. 

At  this  period,  if  at  all,  pleurisy  sets  in.  Its  onset  is  insidious,  and 
it  remains  unrecognised  until  exudate  becomes  abundant.  Physical 
examination  then  reveals  bilateral  dulness  extending  to  a  varying  height, 
and  limited  towards  the  centre  of  the  chest  by  a  horizontal  line  ;  loss  of 
the  vesicular  murmur  over  the  whole  of  this  region  ;  existence  of  a  tubal 
sound  ;  and  disturbance  in  the  respiratory  movements  of  the  chest  and 
flank.  When  these  phenomena  coincide  with  diminution  in  the  pneu- 
monia symptoms,  as  you  saw  in  one  of  our  last  patients,  pleurisy  is 
clearly  indicated. 

*  M.  Brun  obeerved  a  rise  in  temperature  to  42'  C.  in  a  horse  which  afterwards  re- 
covered.    Professor  Cadiot  had  a  similar  case  where  the  temperature  rose  to  41 '9'  C. 


192  CLINICAL    VETKRINARV    MEDICINK    AND    SURCERV. 

Resolution,  anncninced  by  improvement  in  the  general  symptoms, 
by  return  of  appetite,  sinking  of  temperature,  polyuria,  and  sometimes 
by  the  appearance  in  different  parts  of  the  bod}'  of  "  critical  abscesses," 
usually  occurs  a  little  later  and  rather  more  slowly  than  in  simple 
pneumonia.  As  in  the  latter,  the  crepitant  rale  returns  in  the  hepatised 
regions,  and  is  ever}where  gradually  replaced  b}-  the  vesicular  murmur. 
For  some  days  the  patients  have  a  loose  paroxysmal  cough,  and  muco- 
purulent discharge  from  both  nostrils.  Under  suitable  hygienic  con- 
ditions relapses  are  rare. 

A  serious  and  unfortunately  somewhat  frequent  termination  is  gan- 
grene, produced  by  tissue-destroying  toxins  elaborated  b}-  the  pneumo- 
bacteria  alone  or  in  association  with  other  organisms.  Gangrene  is, 
therefore,  either  mono-  or  poly-microbic.  The  general  symptoms  then 
become  still  more  aggravated,  appetite  is  entirel}-  lost,  the  heart  beats 
tumultuously,  the  pulse  becomes  ver}-  feeble  or  is  e\en  lost,  the  tempe- 
rature remains  high,  but  with  sudden  oscillations,  and  a  greyish  stinking 
discharge  sometimes  containing  fragments  of  necrotic  tissue  runs  from 
the  nostrils.  On  auscultation  various  sounds  are  heard  :  tubal  murmurs, 
crepitation,  gurgling,  amphoric,  or  cavernous  sounds,  and  sibilant  rales. 
At  certain  points  the  percussion  sound  is  dull,  at  others  tympanitic  ; 
sometimes  the  bruit  de  pot  fclc  ("cracked-pot  sound")  is  well  marked. 
As  the  gangrene  and  consequent  septic  intoxication  progress,  the  general 
symptoms  become  more  and  more  alarming.  Rigors,  trembling  fits, 
and  sweating  occur;  the  extremities  and  skin  become  cold,  weakness  is 
extreme,  and  the  face  ver}-  anxious.  At  last  the  patient  falls  to  the 
ground  exhausted,  struggles  more  or  less,  and  speedily  succumbs. 
Though  gangrene  is  not  always  fatal,  recovery  is  rare. 

Abscess  formation  in  the  lung  sometimes  occurs  as  an  original  com- 
plication, or  accompanies  gangrene.  It  may  be  suspected,  towards  the 
end  of  the  hepatisation  period,  if,  while  remaining  high,  the  tempe- 
rature oscillate  markedly  and  be  accompanied  by  rigors,  trembling, 
sweating,  groaning,  and  great  loss  of  strength.  So  long  as  the  abscess 
remains  closed,  auscultation  and  percussion  give  little  information  ;  but 
if  one  break  into  a  bronchus  a  cavernous  or  gurgling  murmur  ma}-  be 
detected,  while  on  percussion  tympanitic  resonance  or  the  "  cracked- 
pot  sound  "  is  heard.  A  more  or  less  foetid  purulent  discharge  escapes 
from  the  nostrils.  Whilst  not  invariably  fatal,  pulmonary  suppuration, 
like  gangrene,  is  extremel}-  grave. 

Among  extra-pulmonar}-  complications  myocarditis  occupies  the 
chief  place.  Inflammation  of  the  heart  muscle  occurs  secondarily  during 
the  course  of  infectious  pneumonia,  and  is  clinicall}-  revealed,  as  I  have 
told  you,  b}'  disturbance  of  the  heart  and  pulse.     The  cardiac  contrac- 


CONTAGIOUS    PNEUMONIA.  1 93 

tions  are  at  first  violent  and  palpitating,  afterwards  becoming  more  and 
more  feeble  in  proportion  as  the  muscular  fibres  are  rnore  numerously 
affected  with  fatty  degeneration.  Intermittency  is  often  observed.  On 
auscultation  a  doubling,  rolling,  or  prolonged  first  sound  may  be  heard, 
or  in  exceptional  cases  a  trifling  systolic  or  diastolic  murmur.  The 
pulse  is  irregular,  intermittent,  and  almost  imperceptible. 

Like  the  heart  muscle,  the  endocardium  ma}-  be  injuriously  affected 
b}-  microbes  suspended  in  the  blood,  or  b}-  toxins  emanating  from  the 
pulmonary  centres.  Sometimes  endocarditis  accompanies  myocarditis, 
sometimes  it  develops  singly.  It  usually  affects  the  mitral  or  aortic 
valves,  and  is  generally  accompanied  by  stethoscopic  signs  permitting 
of  diagnosis.  But  too  often  during  an  attack  of  pneumonia  the  state 
of  the  heart  is  neglected,  and  this  complication  altogether  escapes  notice, 
being  only  recognised  long  afterwards  when  the  valvular  insufficiency 
produced  by  contraction  of  the  injured  valves,  or  by  vegetations  deve- 
loped near  their  free  borders   causes  gra\e  functional  disturbance. 

Exudative  inflammation  of  the  pericardium  is  much  rarer  than  that 
of  the  endocardium.  Its  presence  is  indicated  by  the  usual  signs. 
When  trifling  in  quantity  the  exudate  is  only  discovered  on  post-mortem 
examination,  but  \\hen  abundant  it  ma}-  be  recognised  b}-  the  increased 
area  of  precordial  dulness  and  by  the  diminution  or  absence  of  the 
cardiac  sounds. 

Nephritis  is  another  fairly  common  complication,  marked  by  colic, 
restlessness,  difficulty  in  moving  the  hind  limbs,  and  sometimes  by 
hematuria.  The  urine  contains  red  blood-corpuscles  and  renal  casts 
in  which  microbes  may  be  detected.  When  double,  nephritis  usually 
kills  rapidly,  though  in  occasional  instances  death  is  long  deferred. 

Enteritis  first  produces  dull  colicky  pains,  which  gradually  become 
more  severe  and  are  accompanied  by  diarrhoea,  sometimes  b}-  blood- 
stained evacuations. 

Meningo-encephalitis  is  rare.  It  gives  rise  to  excessive  excitement, 
convulsions,  and  epileptiform  attacks,  which  may  or  may  not  alternate 
with  periods  of  coma,  and  usually  proves  fatal  in  a  few  days.  You  saw 
this  complication  in  a  patient  which  died  rapidly  from  bulbar  haemor- 
rhage. 

Meningo-myelitis  and  various  forms  of  toxic  paralysis  may  be  seen 
affecting  among  other  structures  the  recurrent  and  sciatic  nerves,  the 
bladder,  rectum,  and  penis.  The  most  frequent  is  paralysis  of  the 
penis  ;  it  almost  always  appears  during  the  period  of  resolution  ;  in  a 
few  da}-s  the  organ  ma}-  become  greatly  swollen  and  entirely  beyond 
control. 

Contagious   pneumonia,    like   the   abdominal   form   of  influenza,   is 

N 


194  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

sometimes  followed  by  laminitis  affecting  the  front,  the  hind,  or  all 
four  feet.  Certain  myopathic  paralyses,  phlebitis,  and  purpura  are  also 
possible  accidents.  Finally,  the  disease  may  be  complicated  with 
ophthalmia  or  deafness. 

Secondary  inflammations  of  articular  and  tendinous  synovial  mem- 
brane may  appear  early  or  late  in  the  disease.  Sometimes  they  are 
deferred  for  several  weeks  or  even  months  after  the  resolution  period. 
The  commonest  are  those  of  the  sheaths  of  the  great  sesamoid,  and  of 
the  carpus  or  tarsus.  Their  development  was  long  considered  due  to 
retention  in  the  body  of  injurious  products  resulting  from  reabsorption 
of  pulmonary  exudates,  but  like  other  complications  of  pneumonia  they 
are  produced  by  infectious  organisms  or  their  toxins. 

The  anatomical  changes  in  contagious  pneumonia  are  seldom 
limited  to  the  lung  and  pleura,  but  extend  to  the  intestine,  liver,  kidneys, 
heart,  and  sometimes  to  the  serous  membrane,  nerve  centres,  or  to 
other  organs. 

The  lungs  are  almost  always  gravely  affected, — sometimes,  however, 
only  over  a  very  limited  area.  In  the  patient  which  died  from  brain 
complication  you  saw  that  the  hepatised  portion  of  lung  was  hardly  as 
large  as  two  fingers,  and  occupied  the  anterior  part  of  the  right  lobe. 
Friedberger  and  Frohner  believe  that  the  organism  which  usually 
produces  pneumonia  may  affect  a  patient  without  in  any  way  damaging 
the  lung,  but  this  is  certainly  very  exceptional. 

In  general  both  lobes  are  partially  invaded.  Hepatisation  usually 
occurs  in  the  antero-inferior  portion,  extending  upwards  to  a  varying 
and  unequal  height  in  either  lung.  Not  infrequently  the  middle 
(vertical)  section  of  the  lobe  shows  the  greatest  change,  hepatisation 
extending  higher  there  than  in  the  anterior  or  posterior  parts  ;  some- 
times the  lesion  is  limited  to  the  neighbourhood  of  the  large  bronchi, 
the  superficial  layers  escaping.  The  hepatised  parts  are  distinguished 
from  the  rest  of  the  lobe  by  their  deep  blackish  coloration,  and  by 
their  much  greater  density  and  firmness,  even  when  the  healthy  parts 
of  the  organ  are  more  or  less  hypersemic.  Sometimes  they  form  a 
single  uniform  mass,  sometimes  they  show  prominences  and  depressions 
somewhat  resembling  the  condition  seen  in  canine  distemper.  The 
bronchial  glands  are  always  enlarged  and  infiltrated  to  some  extent. 

The  appearance  of  sections  through  hepatised  parts  depends  on  the 
duration  of  the  condition,  and  on  whether  the  pneumonia  is  lobular  or 
lobar. 

In  recent  cases  of  lobar  pneumonia  the  areas  of  hepatisation  are 
blackish  in  colour,  rounded  or  irregular  in  outline,  and  separated  by 


CONTAGIOUS    PNEUMONIA.  1 95 

tracts  of  less  inflamed,  less  hyperaimic  and  still  permeable  parenchyma. 
Sections  through  these  hepatised  areas  present  a  dry  appearance, 
though  elsewhere  a  considerable  quantity  of  frothy  or  sanguinolent 
serosity  escapes  from  the  mouths  of  the  bronchioles  and  vessels. 
Where  hepatisation  is  stilly  more  advanced  the  section  appears  dotted 
with  yellow,  gre}',  or  greenish  points,  and  presents  a  marbled  appear- 
ance resulting  from  the  blending  of  these  colours,  which  indicate 
pulmonary  gangrene.  Little  necrotic  areas  undergoing  delimitation, 
or  already  separated  from  the  adjacent  tissues,  and  bathed  in  greyish 
or  blood-stained  pus,  may  be  seen.  The  bronchioles,  and  sometimes 
the  bronchi  themselves,  are  inflamed. 

In  the  lobar  form  the  lesions  extend  to  the  greater  portion  of  one 
or  both  lobes.  The  non-hepatised  tissue  is  more  or  less  hypera^mic 
and  Arm,  but  not  friable,  becomes  red  on  contact  with  air,  and  gives 
exit  to  an  abundance  of  blood-stained  serosity  ;  the  inflamed  portion  is 
firm,  smooth,  or  slightly  granular  on  the  surface,  and  varies  in  colour. 
In  the  neighbourhood  of  the  congested  parts,  that  is  to  say  in  the  last 
affected  layer,  sections  are  deep  red  with  greyish  points  and  lines  ; 
around  the  bronchi,  towards  the  inferior  margin  and  anterior  extremity 
of  the  lung  where  the  inflammation  has  longest  existed,  sections  are 
less  dariv  in  colour ;  they  exhibit  an  entire  scale  of  colours,  varying 
between  pale  grey  and  brownish  yellow  ;  little  grey  or  yellcrvv  spots  are 
seen  scattered  over  a  brownish  ground,  indicating  necrotic  fragments, 
some  still  in  continuity  with  neighbouring  tissue,  some  in  process  of 
delimitation  and  already  infiltrated  with  pus.  Whether  or  not  suppura- 
tion exist,  these  necrotic  spots  always  exhale  a  foetid  odour,  which  is 
absent  froin  areas  of  simple  hepatisation.  Finally,  cavernous  spaces  of 
all  sizes  between  that  of  a  small  nut  and  of  a  man's  fist  ma}^  be  seen. 
Destruction  of  pulmonary  tissue  is  sometimes  very  extensive.  At  the 
post-uwrteni  of  a  horse  which  died  on  the  tenth  day  I  found  a  large 
cavernous  space  filled  with  sanious  material  in  the  anterior  portion  of 
the  right  lobe.  The  pleura  was  thickened,  much  injected,  and  out- 
wardly adherent  to  the  thoracic  wall  from  the  second  to  the  seventh 
rib  ;  inwardly  to  the  anterior  mediastinum.  The  organs  within  this 
mediastinum  were  glued  together  by  abundant  exudate.  Furthermore, 
in  other  portions  of  the  lungs — particularly  in  the  lower  parts — similar 
cavernous  spaces,  multiple  abscesses  containing  creamy  pus,  and 
necrotic  areas  were  found.  These  lesions  all  contained  many  var}'ing 
species  of  microbes.  Bacteriological  examination  showed  the  presence 
among  others  of  strepto-  and  staphylo-cocci. 

The  specimen  obtained  from  our  last  case  of  pneumonia  exhibited 
lesions  indicating  various  stages  of  contagious  lobar  pneumonia.     With 


196  CLINICAL  vktf:rinarv  medicine  and  sukoerv. 

the  exception  of  a  strip  as  thick  as  a  man's  arm  occupying  the  upper 
border,  the  entire  left  lobe  was  invaded  and  of  a  blackish  tint.  Vertical 
sections  through  the  lung  exhibited  varying  coloration.  In  the  lower 
third,  where  the  parenchyma  was  becoming  or  had  in  places  become 
necrotic,  the  colour  was  greyish  }ellow  marbled  with  darker  lines  and 
spots  ;  in  the  middle  third  the  tissue  was  firmer,  blackish  in  colour, 
and  permeated  with  little  grey  patches  indicating  gangrenous  tissue  ; 
in  the  superior  third,  again,  where  hepatisation  was  recent,  the  appear- 
ance of  the  pulmonary  tissue  recalled  that  of  peripneumonia  (con- 
tagious pleuro-pneumonia)  of  the  ox,  exhibiting  greyish  tracts  of 
irregular  thickness,  surrounding  pulmonary  areas  of  a  pale  brown, 
deep  red,  or  even  blackish  tint. 

Microscopic  examination  of  the  pulmonary  parenchyma  reveals 
more  complex  lesions  than  in  simple  pneumonia.  We  note  first  of  all 
marked  changes  in  the  intra-lobular  spaces,  more  intense  hypergemia, 
more  abundant  diapedesis  of  leucocytes,  which  have  accumulated  in  the 
alveoli  and  around  their  walls  ;  finall}-,  considerable  haemorrhages  at 
many  of  the  points  examined — haemorrhages  which  result  in  entire 
groups  of  lobules  being  surrounded  with  red  blood-corpuscles,  and 
which  b}'  extending  in  all  directions  through  the  intra-lobular  spaces 
produce  a  kind  of  dissecting  effect. 

The  pleura,  which  is  always  attacked  secondarily,  appears  affected 
with  acute  diffuse  pseudo-membranous,  exudative,  or  purulent  in- 
flammation. Two  patients  with  this  complication  died.  One  showed 
lesions  of  exudative  pleurisy,  the  other  of  empyema.  At  the 
post-mortciii  of  the  first  we  found  in  the  pleural  cavity  about  se^•en- 
teen  quarts  of  a  yellowish-grey  liquid  holding  in  suspension  fine 
fibrinous  flocculi.  In  its  lower  parts,  but  especially  over  its  \-isceral 
layer,  the  pleura  was  covered  with  a  layer  of  fibrin,  on  removing 
which  the  serous  membrane  appeared  dull,  infiltrated,  injected,  and 
closely  dotted  over  with  fine  granulations.  In  the  other  the  exudate 
was  reddish,  unmistakably  purulent,  and  rich  in  staph}lococci.  Sown 
on  gelatine  it  produced  white  and  yellow  cultures,  liquefying  the 
medium. 

Other  changes  are  inconstant,  and  result  from  diffusion  by  the 
blood-stream  of  infectious  organisms  or  their  toxins.  These  changes 
can  be  found  in  most  of  the  \-iscera  and  tissues.  I  shall  only  refer  to 
the  principal. 

The  heart  is  often  affected.  In  certain  cases  the  myocardium 
shows  granular  degeneration,  is  more  or  less  swollen  and  softened, 
ecchymosed  in  places,  its  surface  marked  with  greyish  or  }ellowish 
patches,  which  also  appear  on  the  surface  of  sections ;  on  microscopic 


CONTAGIOUS    PNEUMONIA.  197 

examination  the  striation  of  the  fibres  is  ill-defined,  their  contour  is 
irregular,  and  their  substance  infiltrated  with  fine  granulations.  If  the 
endocardium  is  inflamed  the  valves  are  injected  and  infiltrated  ;  some- 
times they  show  a  crop  of  little  yellowish  fibrinous  deposits,  especially 
near  the  free  border.  These  changes  almost  always  affect  the  left 
heart.  Sometimes  the  pericardium  contains  a  little  greyish  liquid,  is 
dull,  covered  with  a  thin  pseudo-membranous  layer,  or  with  fine 
vascular  arborescent  growths. 

The  liver  is  large,  yellowish,  friable,  and  permeated  with  little 
haemorrhagic  centres.  The  hepatic  cells  show  fatty  degeneration. 
The  spleen  is  swollen  or  bosselated,  its  tissue  congested  and  ecchy- 
mosed.  The  kidneys  display  signs  of  diffuse  nephritis.  On  section 
(which  reveals  numbers  of  fine  ecchymoses)  the  cortical  layer  is 
markedly  hypergemic,  and  apparently  more  extensive  than  normal; 
the  medullary  layer  is  reddish  in  tint.  The  microscope  shows  bacterial 
emboli  and  degenerative  changes  in  the  epithelium.  The  intestinal 
mucous  membrane  is  sometimes  hardly  affected,  sometimes  greatly 
congested,  infiltrated,  and  at  certain  points  ecchymosed  ;  at  others  its 
epithelium  has  undergone  desquamation ;  the  lymph  follicles  are 
hypertrophied  and  may  be  necrotic.  The  changes  in  the  nervous 
centres  usuallv  consist  in  more  or  less  intense  hypera;mia  of  the 
meninges  and  of  the  nervous  substance.  In  some  cases  the  meninges 
contain  a  sanguinolent  exudate,  and  occasionally  fine  ecchymoses  are 
found  disseminated  through  the  brain  and  cerebellum,  giving  the  nerve 
substance  a  "sandy"  appearance.  I  have  seen  this  condition  in 
several  animals ;  it  has  been  noted  by  various  authors ;  the  first  two 
instances  were  described  b\'  Laporte.  In  the  patient  of  which  I  was 
just  speaking  we  found  two  hemorrhagic  centres  in  the  medulla,  in 
addition  to  lesions  of  the  brain  proper. 

Certain  muscular  groups  may  become  acutely  inflamed,  the  micro- 
scope revealing  changes  in  structure  similar  to  those  of  the  myocardium. 
The  synovial  membranes  of  tendons  and  joints  sometimes  show  signs 
of  synovitis  or  of  simple  arthritis. 

The  blood,  which  carries  the  agents  producing  all  these  lesions,  is 
itself  more  or  less  changed  in  character.  Its  coagulability  seems 
scarcely  diminished,  but  many  of  the  red  blood-corpuscles  appear 
shrunken  and  in  process  of  destruction,  the  number  of  leucocytes  is 
increased,  more  than  one  species  of  microbes  may  be  present,  and  the 
serum  shows  toxic  qualities. 

When  infectious  pneumonia  develops  regularly  and  terminates  in 
recovery,  the  entire  process  may  be  complete  within  a  fortnight.     As  a 


198  CLINICAL    VETKRINARV    MEDICINE    AND    SURGERY. 

rule  patients  become  convalescent  between  the  tenth  and  fifteenth  days> 
and  resume  work  a  week  or  two  later. 

Instead  of  terminating  in  resolution,  pneumonia  may  assume  the 
chronic  form.  Sometimes  a  few  areas  of  necrotic  parenchyma  become 
surrounded  by  an  irdurated  zone,  and  produce  centres  communicating; 
with  the  bronchi,  into  which  they  pour  infectious  material,  facilitating 
the  spread  of  contagion  by  animals  to  all  appearance  cured.  In  general,, 
however,  such  animals  show  capricious  appetite,  cough,  do  not  attain 
hard  condition,  and  soon  become  exhausted  by  work — symptoms  usually 
referred  to  broken  wind.  Such  chronic  lesions  when  limited  in  area 
may  long  persist  without  producing  appreciable  disturbance,  though  at 
last  bringing  about  acute  fatal  pulmonary  or  pleural  complications. 

When  the  disease  has  already  affected  a  certain  number  of  animals, 
diagnosis  offers  no  difficulty.  Among  the  initial  symptoms  two  are 
particularly  important  and  significant,  viz.  the  rapid  onset  of  fever  and 
the  marked  acceleration  of  breathing.  A  certain  method  of  recognising 
the  onset  of  disease  is  to  note  the  night  and  morning  temperatures  of 
animals  exposed  to  infection.  The  first  cases  may  be  mistaken  for 
the  abdominal  form  of  influenza,  but  the  regularity  with  which  the 
principal  symptoms  appear  in  almost  all  patients,  and  the  constancy  of 
the  pulmonary  affection  (whose  symptoms  dominate  all  the  others), 
soon  remove ^any  uncertainty.  I  have  drawn  attention  to  the  difficult}- 
in  differentiating  between  infectious  and  simple  pneumonia.  I  do  not 
share  the  opinion  of  authors  who  suggest  that  these  two  forms  are  at 
first  clearly  distinguishable  one  from  the  other.  Apart  from  the  history 
— which  of  itself  is  a  useful  guide  in  the  absence  of  well-marked 
clinical  symptoms — the  contagious  character  of  the  one  form  is  soon 
shown  by  the  number  of  cases  which  occur.  Diagnosis  is  confirmed 
by  the  course  of  the  disease,  and  b}-  its  contagious  or  sporadic  cha- 
racter, as  the  case  may  be. 

At  the  present  time  the  differential  diagnosis  of  these  two  varieties 
of  pneumonia  cannot  be  finalh'  established  either  b}-  bacteriological 
examination  or  by  cultivation  methods. 

The  prognosis  of  contagious  pneumonia  is  grave.  The  mortality 
varies  widel}-  according  to  the  time  of  year,  character  of  the  outbreak, 
and  surroundings  of  the  affected  animals,  but  not  infrequently  attains 
to  20  per  cent.  You  have  seen  that  numbers  of  secondary  affections 
occur,  rendering  the  outlook  graver.  Loss  of  appetite,  prolonged 
intense  fever  (^i*^  C. — 105-8°  F.),  and  continual  lying  down  (decubitus) 
are    all    gra^•e  symptoms.     Epidemics  of   pneumonia  are  not  of  equal 


CONTAGIOUS    PNEUMONIA.  1 99. 

malignancy  throughout.  The  greater  number  of  deaths  occur  during 
the  first  half  of  the  period,  probably  because  young  or  very  susceptible 
animals  are  first  affected.  Complex  morbid  conditions  formed  by 
association  of  contagious  pneumonia  with  strangles  or  influenza  are 
particularly  grave. 

Many  difl"erent  methods  of  treatment  have  been  suggested.  The 
most  popular  comprise  counter-irritation  and  administration  of  febri- 
fuges, antiseptics,  and  stimulants.  As  the  general  lines  follow  closely 
on  those  laid  down  when  speaking  of  sporadic  pneumonia  I  shall  only 
indicate  the  modifications  peculiar  to  the  contagious  form. 

Free  application  of  mustard  to  the  thorax,  abdomen,  and  upper 
parts  of  the  limbs  is  always  advantageous.  Bleeding  is  most  useful 
where  depression  is  marked  and  d}-spnoea  menacing.  Subcutaneous 
injections  of  chemical  solutions  and  internal  administration  of  bicar- 
bonate of  soda  restore  the  alkalinity  of  the  blood  and  hasten  elimination 
of  toxins.  Fever  is  diminished  by  administration  of  sulphate  of 
quinine,*  antipyrin,  antifebrin,  or  cold  enemata. 

Among  antiseptics,  creolin,  carbolic  acid,  naphthol,  and  salicylate  of 
soda  are  used.  If  refused  in  the  drinking-water  these  drugs  may  be 
administered  per  rcctuui.  To  favour  disinfection  of  the  intestine 
salicylate  of  soda  or  benzoate  or  subnitrate  of  bismuth,  in  doses  of  ij 
to  2i  drachms,  or  j  to  15  grains  of  calomel  may  be  administered  daily 
during  the  acute  stage.  Intra-tracheal  injections  of  antiseptics  have 
given  encouraging  results. 

Alcohol  is  generally  well  taken,  and  its  action  at  least  compares 
favourably  with  that  of  most  of  the  other  substances  recommended. 
In  common  with  acetate  of  ammonia  it  is  specialh-  indicated  when 
the  strength  shows  signs  of  failing.  Brandy  in  doses  of  4  to  10  ounces 
may  be  given  in  drinking-water  or  electuary.  Cardiac  failure  is  com- 
bated by  digitalis  and  b\'  subcutaneous  injections  of  caffeine  or  ether. 
Purgatives  may  be  cautiously  administered  to  relieve  constipation. 

The  strength  is  sustained  by  liquid  nourishment,  especially  milk, 
and  if  necessary  by  nourishing  enemata.  In  this  disease  good  hygiene 
is  of   primary  importance.     The   animals  must   be   carefully  fed,  and 

*  M.  Leblanc  recently  drew  attention  to  the  value  of.  quinine  Sialts  .in  the  treatment -of 
contagious  pneumonia  and  the  abdominal  form  of  influenza  :  "  At  the  commencement,  when  the 
temperature  suddenly  rises  to  40"  or  41°  C.  (104°  to  1058°  F.),  and  other  symptoms  have 
not  yet  attained  the  gravity  seen  during  the  following  days,  administration  of  minimum 
doses  of  one  and  a  quarter  drachms  of  quinine  sulphate  night  and  morning  rapidly  produces 
in  most  cases  notable  diminution  in  temperature  and  in  the  later  symptoms.  Instead  of  the 
disease  continuing  for  weeks  convalescence  begins  on  the  seventh  or  eighth  day,  and  never 
lasts  beyond  a  fortnight." 


200  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

encouraged  to  take  food  and  drink  at  short  intervals, — every  two  hours, 
or  every  hour  during  the  day  and  night.  If  everything  is  refused,  gruel, 
milk,  or  beef  tea  can  be  administered  by  the  rectum.  Intelligent 
nursing  is  of  the  greatest  value.  It  is  also  very  important  to  keep 
careful  watch  on  healthy  animals  so  as  to  detect  the  onset  of  disease  at 
the  earliest  possible  moment. 

Volatile  antiseptics,  like  oil  of  turpentine  and  carbolic  acid  solution, 
should  be  sprayed  or  scattered  about  the  floor  and  over  the  walls  of  the 
stable. 

During  the  last  few  years  treatment  has  been  enriched  by  two 
special  methods  of  medication,  hydrotherapy  and  serotherapy. 

Hydrotherapy,  already  repeatedly  tested  during  the  present  century, 
consists  essentially  in  the  use  of  the  cold  pack,  that  is  the  application 
to  the  chest  of  compresses  moistened  with  cold  water.  To  produce 
the  most  intense  effects  VVoronzow  used  ice.  In  1890  he  published  the 
results  obtained  in  250  cases  of  pneumonia.  Specially  arranged  packs 
containing  powdered  ice  were  applied  to  the  thorax,  and  renewed 
several  times  per  day  during  the  acute  stage  of  the  disease,  the  patients 
receiving  in  addition  daily  doses  of  I5  to  3  ounces  of  sulphate  of  soda. 
Of  250  animals  thus  treated  only  10  died,  the  mortality,  therefore, 
being  4  per  cent. — a  proportion  certainly  below  the  average  mortality  of 
contagious  pneumonia  treated  by  ordinary  methods.* 

The  seropathic  treatment  consists  in  injecting  under  the  skin  during 
the  febrile  and  hepatisation  periods  serum  obtained  from  animals  which 
have  recovered  from  pneumonia.  The  blood  is  collected  aseptically  in 
sterilised  vessels  by  the  usual  method.  Next  day,  or  even  two  days 
later,  the  serum  is  distributed  in  sterilised  bottles,  containing  I2i  to  25 
fluid  drachms.  In  use  it  is  injected  with  aseptic  precautions  into  the 
subcutaneous  connective  tissue  of  the  neck.  Each  day  five  to  ten 
injections  of  5  fluid  drachms  each  are  made  alternately  on  either 
surface  of  the  neck,  or  into  the  chest  region  over  the  extensor  muscles 
of  the  forearm.  The  liq-uid  is  rapidly  absorbed  without  producing 
abscesses  or  induration. 

Though  Hell,  Wittich,  and  some  other  veterinary  surgeons  have 
only  obtained  negative  or  doubtful  results  with  this  serum.  Topper, 
Zschokke,  Jansen,  and  Jacquot  credit  it  with  immunising  and  curative 
properties.  Granting  that  a  previous  attack  of  pneumonia  really 
confers  immunity  (full  or  modified),  the  blood  should  contain  antitoxic 
substances  during  convalescence.      But  to  obtain  any  benefit  from  the 

*  During  an  outbreak  of  contagious  pneumonia  which  attacked  the  horses  of  the  Bon- 
Marche  at  Paris  M.  Brun  obtained  very  good  results  by  applying  powdered  ice  to  the  thorax 
by  means  of  india-rubber  bags. 


CONTAGIOUS    PNEUMONIA.  20I 

serum  at  least  25  to  60  fluid  drachms  should  be  injected  daily  during 
the  periods  of  onset  and  hepatisation. 

Complications  must  at  once  receive  proper  attention.  If  signs  of 
suppuration  or  pulmonary  gangrene  appear  antiseptics  are  indicated. 
Creolin  or  carbolic  enemata  and  hypodermic  or  intra-venous  injections 
of  carbolic  or  iodine  solutions  should  be  given.  I  need  not  repeat  what 
I  have  already  said  on  this  subject  in  speaking  of  complications  of 
sporadic  pneumonia. 

The  transmissibility  of  the  disease  by  the  various  methods  of  con- 
tagion necessitates  patients  being  isolated  in  a  stable  entirely  apart 
from  that  occupied  by  healthy  animals,  while  both  localities  should  be 
thoroughly  cleansed  and  disinfected,  and  a  separate  attendant  provided 
for  the  diseased. 

When  contagious  pneumonia  appears  in  large  stables,  the  affected 
animals  should  at  once  be  placed  as  far  as  possible  from  the  healthy. 
Even  if  immediately  removed  from  the  common  stable  to  a  neighbouring 
infirmary,  isolation  may  be  insufficient  and  illusory  so  far  as  checking 
the  spread  of  disease.  The  patients  should,  if  possible,  be  sent  to  a 
distant  stable  or  to  the  country,  for  it  seems  clearly  established  that 
change  of  surroundings  almost  always  has  a  favourable  influence,  pro- 
vided the  animals  can  be  removed  at  the  outset  and  without  fatigue. 


XXVIII.— CHRONIC  PLEURISY  IN  THE  HORSE. 

Last  week  a  six-year-old  horse  with  chronic  pleuris}-  was  received 
into  hospital,  where,  however,  it  onl}-  remained  a  short  time.  It  was 
sent  because  during  work  its  breathing  soon  became  distressed,  a  slight 
roaring  sound  being  produced.  The  animal  had  just  been  bought. 
The  purchaser  noticed  an  abnormal  respiratory  sound,  but  referred  the 
accelerated  and  oppressed  breathing  to  broken  wind. 

The  student  who  brought  this  case  before  me  had  not  recognised  the 
condition  from  which  it  was  suffering  from  the  usual  rapid  preliminary 
examination.  You  saw  how  I  arrived  at  the  diagnosis.  The  animal  ap- 
peared bright  and  in  good  health,  but  breathed  rapidly,  with  exaggerated 
movements  of  the  flank  and  chest ;  there  was  complete  dulness  o\-er 
more  than  one  third  of  the  lower  part  of  the  chest,  and  loss  of  the 
v'esicular  murmur  over  the  whole  of  this  region  on  either  side  ;  more- 
over towards  the  centre  line  of  the  chest  a  tubal  sound  could  be 
detected.  These  symptoms  sufficient!}-  indicated  that  the  horse  was 
suffering  from  chronic  pleuris}'  or  h}drothorax.  Of  these  two  expres- 
sions, still  used  by  mauN"  as  synon\mous,  the  first  conve3S  the  idea  of  a 
local  disease,  of  inflammation  of  the  serous  membrane  with  pleural 
exudate  ;  the  second  (h3-drothorax)  suggests  simply  dropsy  of  the  chest, 
a  non-inflammatory  collection  of  fluid  in  the  pleural  sac  produced  b}- 
mechanical  or  constitutional  causes,  b}-  tumours,  by  some  disease  of 
the  lung,  heart,  or  kidne}-,  or  by  cachectic  conditions.  Now  our  patient 
shows  no  disease  of  this  character.  Its  general  condition  is  good,  and, 
I  repeat,  at  first  sight  appears  perfectly  compatible  with  health.  We 
are,  therefore,  not  dealing  with  hydrothorax,  but  with  chronic  pleurisy. 
The  existence  of  roaring  tends  to  confirm  the  inflammator}-  origin  of 
the  condition.  It  is,  in  fact,  extreme!}-  probable  that  the  pleurisy  and 
roaring  depend  on  one  and  the  same  cause,  viz.  a  pre\-ious  attack  of 
pneumonia. 

The  principal  symptoms  noted  on  examining  this  animal  were 
recorded  as   follows  : — "  When    placed   in   a   box   tlie   patient   appears 


CHRONIC    PLEURISY    IN    THE    HORSE.  203, 

rather  dull  and  drowsy.  It  remains  standing  with  the  head  lowered  and 
the  nostrils  dilated.  The  conjunctiva  is  pale  and  slightl}-  infiltrated. 
The  submaxillar}-  artery  is  tense,  and  rolls  under  the  finger  ;  the  pulse 
is  small,  fifty  per  minute.  The  cough  is  infrequent,  slight  and  dry. 
Percussion  is  painful  ;  the  animal  threatens  to  kick,  and  if  its  head  is 
firmly  held,  constanth'  backs  away  from  the  pleximeter  hammer.  The 
area  of  dulness  occupies  almost  half  the  lower  part  of  the  chest  on  both 
sides,  and  is  limited  by  a  horizontal  line.  On  auscultation  the  whole  of 
this  zone  is  absolutely  silent,  except  over  about  eight  inches  of  its  upper 
part,  where  a  tubal  murmur  can  be  heard.  The  rh3thm  of  the  heart  is 
normal ;  the  two  sounds  are,  however,  dull.  There  is  no  serous  infil- 
tration under  the  chest,  or  oedema  of  the  limbs.  The  temperature  is 
39°  C.  (io2'2°  F.).  The  urine  deposits  a  large  quantity  of  sediment, 
but  contains  neither  albumen  nor  sugar." 

During  the  two  days  following  this  examination  the  condition 
remained  stationary.  On  the  door  of  the  box  being  cautiousl}'  opened 
the  horse  took  no  notice,  but  suddenly  lifted  its  head  at  the  least  sound. 
When  excited  its  appearance  became  more  animated,  but  in  a  few 
moments  it  again  appeared  somnolent,  or  began  to  gather  a  few- 
fragments  of  hay  from  amongst  its  litter.  The  temperature  varied 
between  38-8°  and  39-3''  C.  (ior8°  and  102-7°  F-)- 

The  owner  would  not  undertake  the  cost  of  treatment.  He  con- 
sented to  our  tapping  the  chest  to  remove  a  portion  of  the  liquid  which 
was  interfering  with  the  lung's  action,  knowing,  however,  that  improve- 
ment would  only  be  temporary.  We  withdrew  eight  and  a  half  quarts 
of  liquid.     On  the  following  day  the  patient  was  remo\-ed. 

Some  years  ago  I  several  times  saw  an  interesting  case  of  chronic 
pleurisy  in  a  horse  which  had  previously- suffered  from  acute  pleuro- 
pneumonia. In  spite  of  the  use  of  mercurials  internall}-  and  externally 
the  disease  had  assumed  a  chronic  form.  The  animal  was  bought  by  a 
small  horse  dealer.  It  was  then  rather  thin  and  soon  became  "blown" 
at  exercise,  but  when  at  rest  showed  no  well-marked  morbid  S}-mptom 
if  we  except  a  dribbling  of  saliva  from  the  mouth,  consequent  on  the 
action  of  the  mercur3\  This,  however,  the  new  owner  explained  to  us, 
was  in  a  way  an  advantage  in  selling  the  animal,  as  he  referred  the 
trifling  symptoms  shown  to  injuries  about  the  mouth.  A  buyer  \\as 
soon  found.  The  horse  was  fi\-e  }ears  old,  and  the  price  moderate. 
But  from  the  first  day  this  bu3'er  noted  that  the  animal  showed  little 
appetite,  and  soon  had  difficulty  in  breathing  during  work.  He  had  its 
teeth  rasped,  but  finding  the  condition  did  not  improve  he  brought  it 
here  for  inspection.     We  dispelled  his  doubts  as  to  the  animal's  condi- 


204  CLINICAL    VETERINARY    :MEDICINE    AND    SURGERY. 

tion.  It  returned  to  the  seller.  The  latter  (as  happens  almost  always 
under  similar  circumstances)  after  making  a  number  of  difficulties 
consented  to  an  exchange,  needless  to  say  on  terms  advantageous  to 
himself.  He  succeeded  in  successively  selling  this  animal  to  two  other 
persons,  who  brought  it  here  at  intervals  of  a  few  weeks.  We  im- 
mediately recognised  it  by  its  black  colour,  and  by  the  discharge  of 
saliva  which  the  dealer  took  means  to  sustain. 

The  history  of  these  two  horses  shows  you  how  little  marked  may 
be  the  symptoms  of  chronic  pleurisy  even  when  exudate  is  considerable. 
In  many  cases  the  animal  appears  perfectly  well.  All  that  can  be 
detected  in  the  external  appearance  is  a  little  dulness,  trifling  loss  of 
condition,  and  that  peculiar  state  of  the  coat  expressed  by  the  word 
"staring."  Appetite  is  usually  fair;  at  times  capricious  and  irregular, 
hay  especially  being  partly  left.  The  conjunctiva  is  pale  or  clay- 
coloured  and  infiltrated  ;  the  pulse  somewhat  rapid,  of  normal  force  or 
rather  weak.  Fever  is  always  trifling,  and  the  temperature  curve  only 
shows  slight  oscillations.  Some  patients  have  an  occasional  dry 
cough,  louder  than  that  of  broken  wind. 

However  slight  the  exudate,  work  soon  produces  dyspnoea ;  the 
animal  becomes  distressed,  and  finally  stops  for  want  of  breath.  These 
symptoms  grow  more  marked  as  the  area  of  active  lung  is  encroached 
on  by  fluid  exudate.  Even  when  the  pleura  contains  a  considerable 
quantity  of  liquid  some  animals,  when  at  rest,  show  little  change  in  the 
character  of  the  respiration  ;  but  in  the  majoriity — especially  when 
exudate  is  abundant— the  breathing  is  rapid  and  the  "discordance" 
striking.  You  have  all  noticed  that  in  normal  respiration  the  sides  of 
the  chest  and  the  flank  move  simultaneously  and  in  the  same  direction 
during  both  inspiration  and  expiration.  The  flank  flattens  slightly  at 
the  same  moment  as  the  ribs  are  depressed,  and  bulges  when  they  rise. 
'*'  Discordance  "  is  said  to  exist  when  during  expiration  the  flank  bulges 
while  the  ribs  fall,  and  vice  versa.  This  discordance  is  a  common 
symptom  in  various  affections  of  the  lungs  and  pleura,  and  in  some 
other  very  rare  diseases, — in  diaphragmatic  hernia,  for  example.  If 
very  marked  it  almost  always  indicates  pleuritic  exudate. 

Percussion  of  the  thorax  reveals  the  existence  of  a  double-sided  zone 
of  dulness  which  extends  upwards  to  a  greater  or  less  distance, 
reaching  to — or  even  beyond — the  centre  line  of  the  chest.  Above  this 
zone  the  sounds  are  normal  or  tympanitic. 

On  auscultation  the  dull  area  is  usually  silent,  above  this  a  tubal 
sound  is  heard,  and  above  this  again  the  vesicular  murmur.  In 
•exceptional  cases  where  pleuritic  adhesions  exist  a  tubal  murmur  and 


CHRONIC    PLEURISY    IN    THE    HORSE.  205 

liquid  sound  ma}-  be  heard — a  kind  of  splashing  produced  by  the  exudate 
striking  against  bands  of  fibrous  tissue  below  the  level  of  its  surface  (if 
the  expression  be  permissible). 

The  phenomena  discovered  on  auscultation  and  percussion  almost 
always  exist  on  both  sides  of  the  chest  and  to  a  similar  height.  Certain 
cases,  however,  prove  that  exudate  may  be  confined  to  one  pleural  sac, 
and  the  fact  that  the  physical  signs  are  unilateral  does  not  at  once 
exclude  the  diagnosis  of  pleuris\'. 

As  a  rule  the  costal  walls  are  not  abn^  rmali}-  sensitive  except  as  a 
result  of  repeated  stimulating  applications.  In  some  patients  the 
lower  part  of  the  chest  shows  trifling  oedematous  swelling,  and  infiltra- 
tion of  the  subcutaneous  tissues  may  be  detected  by  pressing  with  the 
tips  of  the  fingers  o\er  the  intercostal  spaces. 

Chronic  pleurisy  usually  persists  and  becomes  aggravated,  slowly  if 
the  patients  are  carefully  nursed  and  fed,  but  rapidly  if  they  are  worked 
and  exposed  to  chills  or  inclement  weather.  The  dyspnoea  increases 
in  proportion  to  the  increase  of  exudate.  The  cough,  wasting,  and 
loss  of  strength  become  accentuated,  the  heart-sounds  and  pulse  weaker 
and  weaker.  When  the  increase  of  exudate  is  very  slow  signs  of 
general  debility  appear ;  the  limbs  swell,  and  the  animals  finally  die  of 
exhaustion.  In  the  contrary  case  respiration  soon  becomes  ver}- 
painful,  the  animals  remain  standing  with  the  limbs  spread  widely 
apart,  struggle  for  breath,  and  on  falling  die  of  asphyxia. 

Chronic  pleuris}- in  the  horse  ma}-,  however,  terminate  in  resolution. 
In  rare  cases  the  exudate  ceases  to  increase,  and  after  an  inter\al 
gradually  becomes  re-absorbed.  The  general  disturbance  and  special 
S}-mptoms  recede,  appetite  and  strength  return,  respiration  becomes 
less  frequent  and  difficult,  the  area  of  dulness  diminishes,  the  bronchial 
sounds  disappear,  and  the  ^•esicular  murmur  returns  in  the  lower  parts 
of  the  chest.  Recover}-  is  almost  alwa}s  incomplete,  the  respiratory 
movements  generall}-  remaining  irregular,  and  a  little  dr}-  cough 
resembling  that  of  emphysema  persisting. 

On  post-mortem  examination  of  horses  which  die  of  chronic 
pleuris}-  the  pleura;  contain  a  more  or  less  abundant,  clear,  transparent, 
or  slightly  yellowish  serosity,  with  or  without  fibrous  flocculi  ;  some- 
times the  exudate  is  purulent.  The  pleura  is  irregularly  thickened, 
whitish,  rough  with  villous  processes,  and  partial!}-  co\-ered  with 
masses  of  fibrous  deposit  of  all  shapes  and  sizes ;  sometimes  the 
pulmonar}-  and  costal  or  diaphragmatic  pleurfe  are  adherent.      If  death 


2o6  CLINICAL    VETERINARY    MEDICINE    AND    SURdERY. 

results  in  consequence  of  a  fresh  acute   attack,  these  organised   new 
membranes  are  covered  with  iibrinous  or  purulent  exudate. 

Chronic  pleurisy  being  sometimes  curable,  what  are  the  best  means 
of  treatment  ? 

Internal  medication  is  of  little  value.  In  the  acute  form  bicarbonate 
and  salicylate  of  soda,  given  in  the  drinking-water,  and  pilocarpine  or 
arecoline  administered  subcutaneously  appear  useful,  but  are  of  little 
value  in  the  chronic  stage. 

Laxatives  and  diuretics  internally,  together  with  rubefacients  and 
blisters  applied  to  the  walls  of  the  chest,  constitute  the  usual  treat- 
ment. 

Repeated  mild  blistering  of  both  sides  of  the  chest,  as  high  as  the  line 
of  exudate,  is  sometimes  successful.  When  recent  pleurisy  is  in  process 
of  becoming  chronic  these  most  probably  act  by  favouring  vascularisa- 
tion  of  the  new  membrane,  and  thus  multiplying  the  channels  through 
which  absorption  may  occur.  They  are  less  effectual  in  old-standing 
distinctly  chronic  pleurisy.  In  such  cases  they  should  be  associated 
with  tapping  the  chest.  Many  cases  are  said  to  have  been  permanently 
cured  by  this  treatment. 

In  addition  to  their  questionable  efficacy  in  chronic  pleurisy  blisters 
entail  serious  disadvantages  if  tapping  has  afterwards  to  be  performed. 
The  purulent  dermatitis  they  produce  renders  it  difficult  to  disinfect 
the  seat  of  operation,  and  exposes  the  patient  to  danger  of  pleural 
infection.  When  the  methods  are  combined  the  chest  should  first  be 
punctured,  and  if  a  repetition  of  the  operation  become  necessary  the 
parts  should  be  very  carefully  disinfected. 

Tapping  the  chest  is  unquestionably  the  most  rational  and  efficacious 
method  of  treating  chronic  pleurisy. 

As  the  two  pleural  sacs  almost  always  communicate,  puncture  of  one 
side  results  in  withdrawal  of  most  of  the  contained  liquid.  If  the 
orifices  in  the  posterior  mediastinum  are  plugged  (shown  by  the  per- 
sistence of  exudate  in  the  side  removed  from  that  of  operation),  both 
sides  must  be  tapped. 

In  chronic  as  in  acute  pleurisy  operation  should  be  resorted  to  as 
soon  as  breathing  becomes  distressed  and  exudate  abundant.  Very 
generally  the  two  conditions  march  together,  dyspnoea  being  propor- 
tional to  the  quantity  of  liquid  in  the  thorax.  Nevertheless  exceptions 
occur,  pulmonary  or  cardiac  disturbance  sometimes  rendering  breathing 
difficult  even  when  the  exudate  is  scanty.  Conversely,  cases  occur 
in  which  dN'spncea  is  trifling,  while  the  pleuritic  exudate  is  con- 
siderable.    You  will  see  horses  with  double-sided  abundant  exudates. 


CHRONIC    PLEURISY    IN    THE    HORSE. 


207 


which  only  appear  to  be  suffering  from  broken  wind.  Although  in 
practice  these  cases  are  seldom  surgically  treated,  operation  is  justi- 
fiable and  necessary,  as  large  pleural  exudates  may  cause  sudden  death 
by  asphyxia. 

A  colleague  recently  described  to  me  a  case  of  pleurisy  following 
pneumonia,  in  which  the  horse  died  in  this  way  during  the  fifth  week. 
Having  recognised  how  abundant  was  the  exudate,  he  had  thought  of 
tapping  the  chest  ;  but  as  the  breathing  did  not  appear  alarming  he 
postponed  operation  until  next  day.  The  patient  died  during  the 
night. 

We  may  therefore  lay  down  as  a  general  rule  that  thoracentesis  is 
indicated  whenever  exudate  is  abundant.  When  it  approaches  the 
middle  line  of  the  chest  any  temporising  is  dangerous,  and  operation 
should  at  once  be  performed. 

The  operation  dates  from  the  earliest  historical  period.  In  the  case 
of  man  it  was  performed  by  the  Cnidians  and  the  doctors  of  Cos.  At 
that  time  it  was  usual  to  incise  the  thoracic  wall  through  an  inter- 
costal space,  or  to  trephine  a  rib.  The  "  hippiatres,"  predecessors  of 
the  first  veterinary  practitioners,  applied  this  treatment  to  the  horse, 
Lafosse  indeed  going  so  far  as  to  declare  that  pleurisy  could  only  be 
cured  by  operation.  Following  them,  some  veterinary  surgeons,  during 
the  last  and  commencement  of  the  present  centuries,  opened  the  pleura 
by  passing  the  point  of  a  knife  through  an  intercostal  space.  Thus 
performed,  operation  produced  immediate  relief,  but  was  too  often 
followed  by  infection  of  the  pleura  and  passage  of  air  into  the  thorax, 
which  almost  always  proved  fatal. 

The  first  improvement  consisted  in  substituting  a  trocar  for  the  bis- 
toury. Even  Lafosse,  in  his  Didionnaire  d'Hippiatriqiie,  gives  a  short 
description  of  thoracentesis  by  means  of  the  trocar.  He  recommends 
passing  the  instrument  between  the  lower  portions  of  the  seventh  and 
eighth  ribs,  opposite  the  costal  cartilages,  drawing  off  about  half  the 
contained  fiuid,  and  afterwards  injecting  slightly  stimulating  liquids 
(liquides  legerement  vulneraires).  He  adds  that  the  treatment  is 
"  almost  always  certain  "  when  the  condition  is  of  inflammatory 
origin. 

For  a  long  time  the  trocars  used  were  too  large ;  complications 
were  very  frequent  and  success  rare.  The  operation  had  almost  been 
abandoned  when  it  was  rehabilitated  by  St.  Cyr,  who  showed  the  good 
results  obtained  by  using  a  fine  trocar.  To  prevent  air  entering  the 
chest  Reybard  suggested  providing  the  cannula  with  a  short  tube  of 
goldbeater's  skin,  which  allowed  liquid  to  escape  but  prevented  air 
entering,  the  thin  walls  collapsing  and  closing  the  orifice  when  pres- 


208  CLINICAL    VETKRINARV    MEDICIXK    AND    SURGERY. 

sure  became  negative.  Despite  these  successive  modifications  the 
operation  always  entailed  risk  until  the  introduction  of  antisepsis. 
Though  it  produced  momentary  improvement  it  was  often  followed  by 
aggravation  of  the  disease,  the  pleuritic  exudate  becoming  purulent, 
and  patients  dying  of  emp}-ema. 

Thanks  to  antisepsis,  and  possibl}-  in  some  degree  to  the  invention 
of  M.  Dieulafoy's  aspirator,  thoracentesis  has  become  a  comparatively 
innocent  operation.  Even  without  an  aspirator  the  operation  can  be 
perfectly  well  performed,  provided  a  slender  trocar  be  used  and  anti- 
sepsis observed.  The  seat  of  operation  having  been  shaved  and  dis- 
infected, the  trocar,  covered  by  its  cannula,  is  introduced  at  the  lower 
part  of  the  seventh  or  eighth  intercostal  space  close  to  the  spur  vein  ; 
the  trocar  is  next  withdrawn,  allowing  the  liquid  to  escape,  after 
which  the  cannula  is  removed  and  the  little  cutaneous  wound  covered 
with  a  layer  of  iodoform  or  sublimate  collodion.  This  constitutes  the 
entire  operation. 

With  the  aspirator  the  wound  in  the  thoracic  wall  and  the  danger 
of  infecting  the  serous  membrane  are  reduced  to  a  minimum.  The 
taps  at  the  base  of  the  aspirator  are  first  closed,  and  the  air  exhausted 
from  the  barrel.  A  rubber  tube,  pro\ided  at  its  free  end  with  a  fine 
hollow  needle  previously  sterilised  b}- immersion  in  a  disinfectant,  or  b)- 
passage  through  the  flame,  is  then  slipped  over  one  of  the  aspirator 
nozzles.  The  skin  having  been  prepared  the  needle  is  passed  into  the 
intercostal  space  at  the  point  chosen,  and  the  lower  tap  of  the  aspirator 
opened.  The  needle  is  then  pushed  forward  until  it  enters  the  thoracic 
cavity.  Under  the  influence  of  the  vacuum  in  the  aspirator,  liquid 
rushes  rapidly  into  the  barrel.  Exudate  may  thus  be  removed  in  a 
very  short  time,  but  it  is  better  to  proceed  somewhat  slowh-.  When 
the  liquid  contains  fibrous  clots  the  needle  becomes  blocked  from  time 
to  time,  but  a  little  pressure  on  the  piston  expels  the  fragments,  and  the 
flow  recommences. 

It  is  not  necessar}'  to  remo^■e  all  the  exuded  liquid,  as  has  been 
recommended  b}-  some.  Four  to  twelve  quarts  are  usuall}-  sufficient, 
depending  on  the  size  of  the  animal  and  the  amount  of  exudate. 
Puncture  may  afterwards  be  repeated  if  necessary.  Unless  very 
abundant,  the  remainder  of  the  exudate  becomes  absorbed  sponta- 
neousl}-. 

Resorption  is  fa\oured  b}- administering  alkalies,  diuretics,  or  certain 
drugs  which,  like  arecoline  or  pilocarpine,  stimulate  secretion.  Last 
year  you  saw  in  hospital  a  horse  with  pleurisy  following  pneumonia, 
which  was  only  tapped  once,  one  month  after  the  pleuritic  affection 
had  appeared,  and  was  afterwards  treated  by  alkalies  and  hypodermic 


CHRONIC    PLEURISY    IN    THP:    HORSE.  209 

injections  of  pilocarpine,  the  chest   not   being  bHstered.     The  animal 
recovered. 

When  the  operation  is  properly  performed  the  general  health  always 
improves,  breathing  becoming  easier  and  less  frequent.  The  only 
accident  really  to  be  feared  when  the  operation  has  been  slowly  per- 
formed is  purulent  change  in  the  exudate,  but  this  is  avoided  by 
antiseptic  precautions.  In  another  patient  affected  with  pleurisy 
communicated  from  the  lung,  you  noted  on  the  third  occasion  of 
tapping  that  the  liquid  was  clearh'  purulent,  although  on  the  second 
occasion  it  had  only  been  slightly  turbid,  and  on  the  first  had  appeared 
purely  serous  ;  but  cultivations  from  the  liquid  first  obtained  showed 
pyogenic  germs  ;  the  exudate  was  then  already  purulent,  a  character- 
istic which  had  simply  become  more  accentuated.  In  this  case  tapping 
could  not  be  held  responsible  for  the  change  in  the  exudate. 

Performed  with  proper  precautions  the  operation  is  innocent.  It  is 
always  useful,  and  has  been  found  of  the  greatest  service  in  treating 
obstinate  cases  of  pleurisv. 


XXIX.— THE  ABDOMINAL  FORM  OF  INFLUENZA*  IN 

THE  HORSE. 

During  a  comparatively  short  period  we  have  received  into  hospital 
■eight  horses  suffering  from  an  infectious  disease  which  is  almost  always 
present  in  the  Seine  and  neighbouring  departments,  and  at  times 
assumes  the  form  of  a  true  enzooty.  I  refer  to  the  affection  formerly 
known  as  gastro-enteritis,  and  now  termed  "typhoid  disease,"  "typhoid 
fever,"  or  influenza.  It  is  a  morbid  condition  special  to  the  horse,  and 
has  nothing  in  common  with  the  human  disease  known  by  the  same 
titles. 

On  the  2ist  March  last,  five  horses  belonging  to  M.  A—,  carrier, 
Boulevard  Soult,  Paris,  were  suddenly  taken  ill.  They  were  greatly 
depressed,  and  would  not  touch  their  food.  My  colleague,  M.  Moret, 
was  called  in  next  day,  and  finding  them  undoubtedly  suffering  from 
influenza  had  them  sent  to  the  School.  On  the  30th  of  the  same 
month  three  further  cases  from  this  stable  were  sent  here,  and  during 
the  interval  several  more  had  been  affected. 

I  will  read  you  an  extract  from  the  notes  made  about  these 
animals. 

Case  i. — Four-year-old  entire  horse.     Entered  the  22nd  March. 

Symptoms. — Extreme  depression  and  dulness,  eyelids  swollen  and 
closed,  eyes  painful  on  exposure  to  light,  conjunctiva  cyanotic,  moutli 
hot  and  dr}^,  tongue  slimy,  a  narrow  violet-coloured  stripe  along  the 
gums,  active  thirst,  heart-beats  rapid  and  violent ;  pulse  92,  small  and 
perceptible  with  difficulty;  respirations  21.  Nothing  abnormal  on 
percussing  the  thorax.  On  auscultation,  strong  vesicular  murmur  over 
the  entire  lung.     Temperature  4i'3'^  C.  (106*3°  F-)« 

*  {Maladie  typho'ide  du  cheual.)  To  distinguish  this  form  of  influenza,  of  which  I  saw 
a  large  number  of  cases  in  France,  and  have  recently  seen  others  in  England,  from  "  pink- 
eye," the  form  of  influenza  best  known  to  English  practitioners,  I  have  ventured  to  adopt 
the  above  title,  thus  avoiding  a  long  and  cumbrous  periphrasis. — Jno.  A.  W.  D. 


THE    ABDOMINAL    FORM    OF    INFLUENZA    IN    THE    HORSE.  211 

Treatment. — Application  of  mustard  under  the  chest  and  abdomen, 
and  over  upper  part  of  the  limbs.  Alcohol,  digitalis,  and  salicylate  of 
soda  in  draught.     Carbolic  enemas  of  a  strength  of  '5  to  i  per  cent. 

Next  day  the  symptoms  were  little  changed ;  the  temperature, 
however,  was  only  40*6°  C.  (105°  F.) ;  the  pulse  still  frequent  and 
feeble;  respirations  18  per  minute.  The  animal  took  part  of  its  food. 
After  the  25th  the  condition  markedly  improved.  The  temperature 
did  not  rise  beyond  39*6°  C.  (103-2°  F.)  ;  the  pulse  was  better  and  less 
frequent  than  on  the  previous  day ;  the  respirations  16.  On  the 
following  days  the  symptoms  gradually  diminished.  Recovery  was 
complete  on  the  2gth  March. 

« 

Case  2. — Four-year-old  entire  horse,  entered  hospital  22nd  March. 
The  animal  was  very  depressed  and  sleepy ;  the  head  was  held  low  ; 
the  gait  was  rolling  ;  the  animal  took  no  notice  of  its  surroundings  ;  the 
conjunctiva  was  reddish  violet ;  the  eyelids  were  swollen,  hot,  and  very 
sensitive ;  the  gums  showed  a  broad  bluish  band ;  the  buccal  mucous 
membrane  was  dry ;  thirst  was  intense  ;  appetite  completely  lost ;  the 
heart  beat  tumultuously ;  the  pulse  was  thready,  82  per  minute  ; 
respirations  20;  temperature  40*8°  C.  (i05*4°F.);  nothing  abnormal 
could  be  detected  on  auscultation  or  percussion  of  the  thorax. 

In  the  evening  the  temperature  was  40*5°  C.  (i04"g°  F.) ;  pulse  72  ; 
respirations  18.  The  faeces  were  soft.  Treatment  similar  to  that  of 
the  first  case.  Next  day  the  general  condition  was  stationary. 
Morning  temperature  40'5°  C.  (io4'g'^  F.)  ;  evening  40'8°  C.  (i05'4°  F,). 

On  the  following  days  the  symptoms  diminished  and  the  temperature 
fell.     On  the  31st  March  the  animal  had  entirely  recovered. 

Case  3. — Six-year-old  entire  horse,  entered  22nd  March.  This 
animal  appeared  externally  like  the  others.  The  eyelids  were  swollen 
and  painful,  tears  running  from  the  eyes;  the  conjunctiva  was  injected, 
infiltrated,  and  of  a  very  marked  mahogany  colour.  The  mouth  was 
hot ;  the  mucous  membrane  of  the  gums  violet  in  colour ;  the  fseces 
were  dry.  The  temperature  was  40'6°  C.  (105°  F.) ;  the  circulation 
very  rapid  ;  the  pulse  go  and  difficult  to  detect ;  respirations  20  per 
minute. 

Treatment  as  before  with  the  addition  of  eight  ounces  of  sulphate 
of  soda. 

The  first  three  days  the  condition  remained  nearly  stationary. 
Temperature  40*5°  C.  (i04'g°  F.)  ;  pulse  88  ;  respirations  18.  Subse- 
quent course  of  the  disease  similar  to  that  in  the  above  patients. 


212  CLINICAL    VETERIXARV    MEDICINK    AND    SURGERY. 

Case  4.— Seven-year-old  entire  horse,  entered  22nd  March.  The 
animal  was  dull  and  stiff,  and  remained  standing  in  a  corner  of  its 
box.  The  eyes  were  weeping;  the  eyelids  swollen,  infiltrated,  and 
painful;  the  conjunctiva  of  a  reddish  mahogany  colour;  the  cornea 
had  lost  its  transparency,  and  was  encircled  by  a  yellowish  aureola  ; 
the  anterior  chamber  contained  a  deposit  resembling  hypopyon.  These 
symptoms  were  particularly  marked  in  the  left  eye.  The  mouth  was 
hot  and  dry,  the  tongue  slimy,  the  gums  marginated  by  a  bluish  line  ; 
appetite  sHght ;  thirst  severe  ;  temperature  40*6°  C.  (105°  F.) ;  pulse 
78  ;  respirations  22.  Treatment  the  same  as  for  the  two  previous 
cases. 

On  the  following  day  trifling  improvement  was  noted.  The  horse 
was  less  depressed,  and  ate  the  greater  part  of  its  food.  Temperature 
3g"8°  C.  (103-6°  F.),  pulse  80,  respirations  20.  The  faeces  were  small, 
dry,  and  shiny.  Eight  ounces  of  sulphate  of  soda  were  given  in  the 
dri-nking-water. 

Marked  improvement  occurred  on  the  following  da}s.  Recover}- 
was  complete  on  the  seventh  day,  except  that  the  circle  around  the 
cornea  had  not  quite  disappeared. 

Case  5. — Six-year-old  entire  horse,  entered  22nd  March.  The 
following  symptoms  were  noted  : — The  attitude  suggested  great  fatigue, 
the  face  appeared  sleepy,  the  e}-es  were  half  closed,  discharging  tears, 
and  very  sensitive  on  palpation  ;  the  eyelids  were  swollen,  the  con- 
junctivae violet-red,  the  mouth  hot  and  pasty.  The  patient  took  the 
greater  part  of  its  food,  but  would  not  touch  the  chaff;  thirst  was 
severe.  The  heart-beats  were  regular,  the  pulse  feeble,  temperature 
397°  C.  (i03"4°  F.),  pulse  56,  respirations  20.     Treatment  expectant. 

Next  day  the  general  condition  was  stationar}-.  On  the  24th 
improvement  occurred  and  rapidl}'  increased.  On  the  28th  the  animal 
was  removed,  cured. 

Case  6. — Eight-year-old  entire  horse,  brought  to  the  College 
30th  March.  Had  been  ill  since  the  previous  night.  The  animal  was 
depressed  and  somnolent,  and  carried  the  head  low.  The  eyelids  were 
swollen,  the  eyes  weeping,  the  conjunctivae  reddish  violet,  the  cornea 
was  surrounded  by  a  greyish  oedematous  circle,  the  mouth  was  dry,  the 
tongue  coated,  the  line  along  the  gums  well  marked.  The  bowels 
were  constipated,  the  fa;ces  dry  and  covered  with  a  la^'er  of  mucus. 
The  temperature  was  40*1°  C.  (104-1^  F.),  respirations  ig,  pulse  75, 
very  small.  Treatment  similar  to  that  of  Case  3.  Recovery  in  eight 
days. 


THE    ABDOMINAL    FORM    OF    INFLUENZA    IN    THE    HORSE.  213 

Case  7. — Five-year-old  entire  horse,  recognised  as  ill  on  the  2gth 
March ;  brought  to  the  College  on  the  afternoon  of  the  30th. 

The  animal  was  greatly  depressed,  and  walked  with  a  rolling  motion, 
the  muscular  weakness  being  such  that  the  limbs  almost  collapsed  at 
each  step.     The  ears  and  membranes  were  cold. 

Placed  in  a  box  the  animal  stood  constantly  in  one  position,  the 
head  depressed,  the  eyelids  almost  completely  closed,  and  tears  running 
abundantly  over  the  face ;  the  conjunctiva  was  of  a  very  marked 
violet-red  tint ;  the  gums  were  bordered  by  a  stripe  of  the  same  colour, 
more  especially  marked  in  the  lower  jaw  ;  the  temperature  was  4i'3°  C. 
(io6*3°  F.).  The  animal  occasionally  had  paroxysms  of  coughing,  the 
cough  being  strong  and  dry.  On  auscultation  the  vesicular  murmur 
was  absent  from  the  lower  part  of  both  pulmonary  lobes,  being  replaced 
by  moist  rales.  The  respiration  was  22  per  minute,  the  circulation 
rapid,  the  cardiac  beats  being  strong  though  rhythmic  ;  the  pulse  was 
70,  small  and  thready.  Although  appearing  severely  attacked  the 
patient  voluntarily  took  food.     The  fseces  were  normal. 

Same  treatment  as  for  Case  i.  Condition  stationary  for  forty-eight 
hours.  On  the  third  day  improvement  was  noted.  The  normal  respi- 
ratory murmur  had  returned  at  points  where  it  was  previously  imper- 
ceptible. Temperature  40*1°  C.  (i04"i°  F.),  respirations  14,  pulse  55. 
The  improvement  gradually  continued  without  incident.  On  the  5th 
April  the  animal  recovered  its  usual  appearance,  ate  all  its  food,  the 
stiffness  had  disappeared,  the  conjunctiva  showed  a  yellowish  tint, 
temperature  38*^  C.  (100*4°  F-^?  respirations  15,  pulse  40. 

On  the  8th  April  the  patient  was  sent  home  cured. 

Case  8. — Six-year-old  entire  horse,  entered  the  School  30th 
March. 

Principal  Syinptoins. — Very  pronounced  depression,  somnolence  and 
lolling  gait ;  eyelids  half  closed  and  swollen  ;  conjunctiva  hyperaemic  ; 
mouth  hot ;  tongue  coated ;  gums  bordered  by  a  narrow  violet-coloured 
stripe.  Auscultation  and  percussion  of  the  thorax  revealed  nothing  ab- 
normal. Temperature  40*2°  C.  (i04'3°  F.)  ;  respirations  26;  pulse  70, 
difficult  to  discover  in  the  arteries  of  the  extremities. 

Treatment. — Expectant. 

The  animal  took  a  portion  of  its  food.  On  the  31st  March  and  ist 
April  the  condition  was  stationary. 

On  the  2nd  April  the  animal  was  less  depressed,  and  the  discharge 
from  the  eyes  had  diminished.  The  temperature  was  only  39*3°  C. 
(I02'7°  F.).     Recoverv  was  complete  on  the  sixth  day. 

These  are  typical  cases  of  benign  influenza,  rapid  in  onset  and  in 


2  14  CLINICAL    VETERINARY    INIEDICINE    AND    SURGERY. 

development,  and  unaccompanied  by  any  grave  complication.  Even 
in  this  form  the  disease  appears  suddenly,  and  soon  reveals  its  presence 
by  three  clearly  marked  symptoms — extreme  depression,  high  fever, 
and  deep  red  or  violet  tint  of  the  conjunctiva.  If  you  have  carefully 
observed  and  followed  these  cases  you  have  noted  other  morbid  pheno- 
mena. In  all  the  mouth  was  hot  and  dr}^,  its  mucous  membrane  in- 
jected, and  the  gums  showed  the  classical  reddish-violet  line.  The 
majority  showed  no  intestinal  trouble.  The  faeces  were  of  normal 
consistence.  Three  patients  were  constipated  during  the  earlier 
period  ;  only  one  had  diarrhoea.  In  none  was  palpation  of  the  abdo- 
men painful.  The  circulation  was  greatly  accelerated,  the  pulse  often 
numbering  go  per  minute,  and  the  force  with  which  the  heart  beat 
contrasted  markedly  with  the  weakness  of  the  pulse,  which  was  small 
and  thread}^ — in  some  patients  so  feeble  as  to  be  difficult  to  count 
during  the  first  few  da3-s.  Auscultation  of  the  heart  revealed  no 
abnormal  sound.  The  breathing  movements  were  little  affected, 
either  in  number  or  rhythm.  Auscultation  of  the  lung  only  showed  a 
trifling  exaggeration  of  the  vesicular  sound.  In  one  patient,  however, 
during  the  second  and  third  days  the  lower  portion  of  both  lobes,  and 
especially  of  the  left,  was  the  seat  of  moist  rales  and  loss  of  the 
vesicular  murmur^ — signs  which  were  referred  to  congestion  of  the 
lower  portion  of  the  lung.  This  was  the  only  animal  which  had  any 
attacks  of  coughing.  The  skin  of  the  trunk  and  upper  portions  of  the 
limbs  was  hot.  In  most  of  the  patients  the  ears  and  extremities  were 
cold.  In  almost  all  the  fever  was  marked,  the  temperature  rising 
above  40°  C.  (104°  F.),  in  several  even  above  41°  C.  (105*8°  F.). 

In  two  cases  the  eyes  were  specially  affected.  In  addition  to  the 
epiphora,  the  violet  coloration  and  infiltration  of  the  conjunctiva,  the 
cornea  and  deeper  portions  of  the  eye  showed  lesions.  In  these 
patients  the  cornea  of  both  eyes  was  surrounded  by  a  greyish  oede- 
matous  circle,  and  in  one  of  the  two  the  anterior  chamber  of  the  eye 
contained  a  deposit  resembling  hypopyon.  These  troubles  disap- 
peared in  a  few  days.  The  fear  of  light  at  first  observed  only  per- 
sisted for  forty-eight  hours. 

There  was  no  oedematous  swelling  of  the  lower  parts  of  the  limbs, 
and  no  paralysis  of  the  penis  or  other  organs.  The  rapid  diminu- 
tion in  symptoms,  prompt  and  complete  resolution,  and  short  con- 
valescence were  particularly  remarkable  in  all  cases.  The  animals 
were  put  to  work  soon  after  leaving  hospital. 

Influenza,  however,  does  not  alwa}s  present  this  benign  character, 
and  when  it  takes  a  malignant  form  many  patients  die  of  intestinal,. 


THE    ABDOMINAL    FORM    OF    INFLUENZA    IN    THE    HORSE.  215 

pulmonary,  cardiac,  or  encephalic  complications.  Since  it  has  per- 
manently taken  up  its  residence  here  it  seems  in  a  general  sense  to  have 
lost  some  of  its  gravity.  During  1890  and  i8gi  it  is  said  to  have 
produced  many  deaths  in  Paris  and  the  neighbourhood,  but  the 
evidence  is  not  entirely  satisfactory  as  to  whether  the  cause  of  these 
losses  was  influenza  pure  and  simple.  In  great  commercial  and 
industrial  centres,  where  circumstances  favour  the  development  and 
propagation  of  contagious  equine  diseases,  several  infections  may 
simultaneously  be  active  in  one  stable.  Thus  influenza  sometimes 
co-exists  with  strangles,  contagious  pneumonia,  or  the  pneumo-enteritis 
caused  by  bad  forage.  I  have  observed  cases  of  the  kind.  You  will  there- 
fore see  how  difficult  it  sometimes  is  to  solve  these  questions,  and  how 
much  more  complicated  the  problems  offered  by  practice  really  are 
than  you  might  imagine  by  perusing  text-books  on  pathology. 

At  the  post-inorteui  examination  of  animals  dead  of  influenza  most 
of  the  organs  exhibit  extensive  changes :  congestion,  ecchymoses, 
infiltrations,  and  degenerative  changes  only  revealed  by  the  microscope 
occur  in  varied  combination,  but  the  principal  lesions  are  confined  to 
the  mucous  membranes  of  the  digestive  and  respirator}'  apparatus. 
The  intestinal  mucous  membrane  is  hyperaemic,  swollen,  ecchymosed, 
and  in  places  deprived  of  its  epithelium.  When  incised  it  appears 
infiltrated  with  liquid  which  escapes  from  the  cut  surfaces,  and 
coagulates  in  thin  layers  of  gelatinous  character.  The  submucous 
connective  tissue  is  often  engorged  with  greyish  or  amber-coloured 
liquid.  The  mucous  membrane  of  the  pyloric  end  of  the  stomach  and 
sometimes  of  the  phar3Tix  shows  similar  changes. 

Swelling  of  Peyer's  patches  is  b}-  no  means  constant,  and  I  have 
never  observed  necrosis  or  ulceration,  lesions  characteristic  of  typhoid 
fever  in  man  ;  moreover  Eberth's  bacillus,  the  causal  microbe  of  typhoid, 
is  never  found  either  in  these  patches  or  at  any  other  point  in  the 
intestine.  The  respiratory  mucous  membrane  is  affected  to  a  varying 
degree.  Often  there  is  onl}-  reddening  and  slight  swelling  of  the  larynx 
and  bronchi ;  in  some  cases  pulmonary  lesions,  such  as  catarrhal  or 
fibrinous  pneumonia,  or  oedema  of  the  lung,  with  or  without  pleural 
exudate,  predominate.  Disease  of  the  in}'ocardium  and  endocardium 
is  rarer  than  in  pneumonia.  Even  when  nervous  symptoms  occur, 
change  in  the  brain,  spinal  cord,  or  meninges  is  seldom  marked  ;  very 
often  there  is  only  trifling  injection  of  the  meninges  and  slight  infiltra- 
tion of  the  plexuses,  the  true  nerve  substance  either  of  the  brain  or 
medulla  being  rarely  ecchymosed  or  softened.  When  the  disease  is  com- 
plicated with  laminitis  the  podophyllous  tissue  is  more  or  less  congested. 


2l6  CLINICAL    VKTERINARV    MKDICINE    AND    SURCKRY. 

The  blood  and  affected  organs  may  contain  various  microbes,  but 
none  of  those  at  present  isolated  can  be  regarded  as  the  specific  agent 
of  influenza.     That  remains  to  be  discovered.* 

Diagnosis  is  easy.  The  sudden  appearance,  rapid  aggravation  of 
symptoms,  extreme  depression,  and  the  ocular  symptoms  constitute  the 
principal  indications.  Any  doubts  which  might  at  first  exist  are  soon 
dissipated  by  the  rapid  spread  of  disease  to  large  numbers  of  fresh 
subjects.  In  less  than  a  fortnight  one  half  or  two  thirds  of  the  animals 
in  a  large  stable  may  be  attacked. 

The  disease  can  be  distinguished  from  contagious  pneumonia  and 
from  the  pneumo-enteritis  said  to  be  produced  by  bad  fodder. 

Contagious  pneumonia  is  recognised  by  the  predominance  of  pul- 
monary symptoms  ;  the  rapidity  of  breathing  from  the  outset ;  the 
slighter  depression  ;  the  absence  of  epiphora  ;  the  yellowish  colour  and 
moderate  injection  of  the  conjunctiva,  and  the  slow  extension  of  the 
epidemic.  The  embarrassing  cases  are  those  where  infection  is  of  a 
mixed  character, — influenza  and  contagious  pneumonia,  for  instance, 
being  both  present  in  one  stable. 

The  existence  of  pneumo-enteritis  is  usually  announced  by  some- 
what alarming  symptoms,  but  in  general  the  onset  is  less  striking  and 
the  contagion  less  active  than  in  influenza.  The  conjunctiva  is  less 
swollen,  and  lacks  the  violet  or  mahogany  colour.  If  the  colour, 
appearance,  and  smell  of  the  hay  and  oats  leave  nothing  to  be  desired, 
if  they  are  clean,  have  been  well  got  and  carefully  stored — if,  in  a  word, 
they  are  of  excellent  quality,  pneumo-enteritis  may  be  placed  out  of  the 
question.  It  is  always  easy  to  distinguish  influenza  from  sore  throat, 
or  bronchitis  affecting  a  number  of  animals. 

The  prognosis  is  usually  favourable,  but  varies  according  to  the 
character  of  the  prevailing  outbreak,  the  time  of  3'ear,  and  the  animals' 
surroundings.  When  the  disease  seizes  on  a  locality  from  which  it  has 
long  been  absent,  more  animals  are  lik-ely  to  succumb  than  in  large 
towns  where  it  exists,  so  to  speak,  permanently.  This  year  we  have 
seen  little  but  benign  cases  which  developed  regularly  and  rapidly. 
All  our  cases  of  simple  influenza  recovered,  but  the  mortality  is  some- 
times severe,  varying  between   i  and   15  per  cent.,  the  medium  being 

*  M.  Lignieres  isolated  and  cultivated  a  microbe  which  he  termed  the  cocco-baciHiis,  and 
which  he  regarded  as  the  specific  cause  of  influenza  in  the  horse.  He  states  that  "  inocu- 
lation of  a  horse  with  a  culture  of  this  microbe  produces  most  characteristic  symptoms  of 
influenza."  Suitably  attenuated  and  inoculated  into  a  healthy  horse  it  produces  no  grave 
symptom  and  affords  immtmity.  By  vaccinal  inoculation  in  the  horse  a  preventive  and 
<-urative  serum  was  obtained. 


IHK    ABDOMINAL    FORM    OF    INFLUKNZA     IN    THK    HORSK.  217 

from  3  to  5  per  cent.  The  outbreaks  in  which  losses  rose  to  25,  50,  or 
60  per  cent,  were  not  due  simply  to  influenza,  but  were  the  result  of 
double  infection. 

An  interesting  point  to  consider  is  whether  the  virus  oi  influenza 
has  immunising  properties,  and  whether  animals  which  have  recovered 
are  protected  from  fresh  attacks.  In  this  respect  experience  shows 
that  the  disease  generally  affords  immunity  for  a  period  of  twelve  to 
fifteen  months.  In  i8gi  a  stable  of  twenty  horses  was  invaded  by 
influenza,  and  I  noted  that  two  animals  which  had  been  attacked  ten 
months  before  resisted. 

Cases  of  more  prolonged  immunity  have  been  mentioned,  some 
extending  to  three,  five,  or  six  years.  These  are  exceptional,  even 
admitting  that  the  disease  has  not  been  erroneously  described  as 
influenza. 

Treatment  consists  primarily  in  good  hygiene.  In  recent  outbreaks 
where  the  number  of  cases  is  still  small  the  patients  should  be  isolated 
and  their  stalls  disinfected ;  the  stable  should  be  kept  well  ventilated 
and  very  clean  ;  the  drains  being  flushed  and  the  floor  and  walls 
moistened  with  carbolic,  creolin,  or  turpentine  solutions.  In  this  way 
the  epidemic  may  be  arrested,  but  its  contagious  character  is  too 
pronounced  for  such  measures  often  to  succeed  ;  nevertheless  they 
should  not  be  neglected.  If  the  form  of  disease  is  severe  and  many 
animals  are  affected,  it  may  be  necessary  to  remove  all.  In  warm 
weather  they  can  be  turned  out  to  grass,  living  in  the  open  air  under  a 
shed  ;  at  least  they  should  be  removed  to  a  new  stable  and  the  infected 
stable  thoroughly  disinfected.  By  observing  these  precautions  in  grave 
outbreaks  of  influenza  many  practitioners  have  succeeded  in  checking 
the  heavy  mortality  and  the  disease  itself. 

Patients  which  still  drink  freely  should  receive  gruel,  hay  tea,  or 
milk  at  frequent  intervals.  Milk  is  particularly  valuable;  most 
animals  drink  it  readily  ;  in  grave  cases  it  is  alone  sufficient  to  sustain 
their  strength  and  carry  them  on  beyond  the  dangerous  period.  As  in 
pneumonia,  patients  which  refuse  everything  should  be  fed  by  the 
rectum. 

Medical  treatment  comprises  various  methods,  the  principal  being 
bleeding,  application  of  large  mustard  plasters  to  the  chest  and 
abdomen,  and  the  internal  administration  of  drugs.  Those  most 
commonly  given  are  sulphate  of  soda  in  doses  of  3  to  6  ounces  per  day, 
bicarbonate  of  soda  1 1  to  3  ounces,  salicylate  of  soda  ih  to  6  drachms, 
digitalis   4  to   i^  drachms,  and  quinine  salts  2^  to  5  drachms.     The 


2i8  CLINICAL  vetf:rinarv  medicine  and  surgery. 

eyes  are  treated  with  lukewarm  fomentations  and  warm  collyria 
containing  atropine,  creolin,  or  boric  acid.  If  fever  remains  high  anti- 
pyretics and  cold  enemata  (to  which  li  to  3  drachms  of  carbolic  acid 
per  quart  may  be  added)  are  useful.  When  influenza  is  complicated 
with  laminitis,  hypodermic  injections  of  arecoline  or  pilocarpine  are 
valuable  ;  the  feet  should  be  surrounded  with  moist  compresses^ 
frequently  saturated  with  cold  water. 

In  the  various  forms  of  influenza,  moderate  doses  of  alcohol,  and 
especially  brandy,  may  be  given  either  in  the  drinking-water  or  in  the 
form  of  electuary.  You  have  often  seen  valuable  effects  thus  obtained. 
The  mode  in  which  alcohol  acts  has  long  been  discussed,  but  whether 
it  undergoes  a  series  of  transformations  in  the  blood,  whether  it 
principally  affects  the  nervous  system  or  nutrition,  is  of  little  importance. 
What  we  do  know  is  that  it  gives  excellent  results.  In  six  of  our 
patients  treatment  consisted  in  application  of  mustard  plasters  and  the 
administration  in  mashes  or  gruel  of  sulphate  of  soda,  bicarbonate  of 
soda,  salicylate  of  soda,  and  brandy.  For  several  I  also  ordered  ^  to  i^ 
drachms  of  powdered  digitalis  and  cold  carbolic  enemata.  All  cases 
recovered  very  rapidly. 

I  wish  to  impress  on  30U  that  in  the  benign  form  of  influenza 
internal  medication  is  only  of  secondary  importance.  I  left  two 
patients  to  take  care  of  themselves,  without  assisting  them  in  any  way 
whatever,  only  watching  them  in  case  it  should  become  needful  to 
intervene.  No  necessit}*  arose,  and  both  recovered  as  quickly  as  those 
treated. 


XXX.— A   CASE   OF    PHARYNGITIS    DUE    TO    STRANGLES. 

We  have  just  completed  the  autopsy  of  a  horse  which  died  of 
acute  sore  throat  due  to  strangles,  complicated  by  paralysis  of  the 
pharynx.  Up  to  the  last  day  or  two  we  anticipated  improvement  and 
recovery ;  the  symptoms  never  appeared  alarming  or  likely  to  end  in 
death,  and  in  fact  were  even  less  pronounced  than  usual  in  such 
attacks.  For  that  reason  alone  the  case  is  of  special  clinical  interest. 
The  history  of  this  patient  will  form  the  subject  of  m}-  lecture  to-day. 

The  animal  was  brought  for  advice  on  the  6th  September.  It  was 
five  years  old,  and  had  only  been  four  days  in  the  new  owner's  stable.  On 
that  morning,  and  even  on  the  evening  before,  it  left  the  greater  part 
of  its  food,  and  seemed  tired  and  depressed ;  the  skin  was  hot,  the  eye 
injected ;  a  greyish  inodorous  discharge  mixed  with  fragments  of  food 
ran  from  both  nostrils ;  saliva  accumulated  in  the  mouth,  and  escaped 
freely  on  introducing  the  hand.  The  throat  was  painful  on  pressure. 
The  right  submaxillary  gland  was  slightly  enlarged,  the  left  formed  a 
swelling  the  size  of  a  walnut,  and  was  surrounded  by  an  cedematous 
zone  ;  the  centre  showed  obscurely  fluctuation.  A  few  small  papules 
were  noticed  at  different  points,  especially  on  the  neck  and  sides.  The 
patient's  age  and  the  fact  that  it  had  just  been  bought  at  once 
suggested  to  us  the  diagnosis  of  pharyngitis  due  to  strangles.  I  opened 
an  abscess  under  the  jaw  with  the  usual  precautions,  and  collected  a 
little  pus,  which  I  found  to  contain  streptococci  in  short  chains. 
Being  left  for  treatment  the  animal  was  placed  in  my  portion  of  the 
hospital. 

My  assistant  will  read  you  the  animal's  history  from  the  time  when 
it  entered  hospital  until  the  da}-  of  its  death. 

"On  entering  hospital  the  animal  was  depressed  and  took  no 
notice  of  its  surroundings.  It  scarcely  touched  food.  A  greyish 
discharge  mixed  with  small  quantities  of  food  ran  from  the  nostrils,  and 
long  strings  of  saliva  occasionally  fell  from  the  mouth  :  the  conjunctivai 


220  CI.INICAl.    VKIKRIXARY    MKDICINK    AND    SUR(iERV. 

were  deep  red  in  colour.  The  pulse  was  70  per  minute  and  strong  ; 
the  respirations  32  ;  the  temperature  40*5°  C.  (104*9°  F-^-  The 
vesicular  murmur  was  loud  over  the  entire  area  of  both  pulmonary 
lobes.  The  submaxillar}^  glands  were  swollen,  the  left  showing 
fluctuation.  A  papulo-vesicular  eruption  was  visible  on  the  neck,  sides, 
flanks,  and  croup. 

Treatment. — The  abscess  was  opened  and  the  cavity  washed  out 
with  a  watery  solution  of  iodine.  The  sides  and  under  surface  of  the 
thorax,  throat,  and  limbs  were  dressed  with  mustard.  Food  as  usual, 
hay  tea,  and  milk.  Fumigations  :  2\  drachms  of  sulphide  of  antimony 
{Kermes'  mineral),  5  ounces  of  brandy,  and  creolin  enemas. 

Until  the  loth  September  the  temperature  remained  at  40°  C. 
{104°  F.),  the  pulse  varied  between  55  and  70,  and  the  respirations 
between  22  and  30  ;  cough  was  infrequent.  On  auscultating  the  lung 
mucous  rales  were  heard  ;  the  vesicular  murmur  appeared  diminished 
over  the  inferior  third  of  both  lobes.  The  animal  readily  took  mashes, 
etc.,  and  10  quarts  of  milk  per  day.  The  Kermes'  mineral,  alcohol, 
and  creolin  were  continued.  A  daily  dose  of  2^  drachms  of  potassium 
iodide  was  added. 

From  the  nth  to  the  i8th  September  the  symptoms  continued, 
though  slight  improvement  occurred  and  slowly  became  more  marked. 
On  certain  days  the  temperature  fell  to  39°  C.  (102*2°  F.),  the  pulse  to 
48,  and  the  breathing  to  20.  The  patient  occasionally  attempted  to 
eat  oats  and  hay  ;  it  masticated  them,  but  had  great  difficulty  in 
swallowing  the  little  boluses  of  food,  so  that  although  it  continued  to 
take  gruel,  hay  tea,  antl  milk,  wasting  occurred.  On  the  13th  a  second 
abscess  developed  under  the  jaw  behind  the  previous  one,  and  was 
opened.  Bacteriological  examination  of  the  pus  revealed  the  presence 
of  streptococci. 

On  the  19th  the  general  condition  was  distinctly  better,  and  the 
discharge  less  abundant  than  on  the  preceding  days.  Saliva  still  ran 
from  the  mouth,  but  when  the  animal  drank  less  water  returned 
through  the  nostrils.  The  submaxillary  space  still  showed  inflammatory 
swelling  occupying  the  posterior  half  and  extending  over  the  laryngeal 
region.  A  few  oats  given  by  hand  were  masticated,  but  not  swallowed. 
On  examining  the  throat  nothing  could  be  found  to  explain  this  inability 
to  swallow.  The  parotid  region  was  not  swollen  or  more  prominent 
than  normal,  and  pressure  over  it  only  caused  dull  pain,  the  animal 
scarcely  attempting  to  withdraw.  Three  little  abscesses  the  size  of 
hazel-nuts  had  developed  in  the  subcutaneous  connective  tissue  of  the 
right  shoulder.  They  were  opened.  Careful  examination  of  the 
buccal  cavity,   especially  towards  the  back   and   base   of   the  tongue. 


A    CASE    OF    PHARVN(;iTIS    DUE    TO    STRANGLES.  221 

showed  nothing  abnormal.  Nothing  was  discovered  on  rectal  examina- 
tion. Temperature  38*8°  C.  (ioi"8°  F.),  respirations  18,  pulse  40.  The 
urine  contained  no  sugar,  though  a  little  bile  pigment  and  traces  of 
albumen  were  found. 

"  On  the  20th  the  general  condition  ^\•as  stationar}-.  The  penis  had 
become  relaxed  and  pendent.  As  slight  signs  of  iodism  had  occurred 
and  tears  ran  over  the  cheeks  the  potassium  iodide  was  stopped. 

"  On  the  two  following  days  the  penis  became  more  marked!}-  para- 
lysed.    Emaciation  also  increased. 

"  On  the  23rd  the  general  condition  was  less  favourable,  and  saliva- 
tion more  abundant.  The  patient  showed  greater  depression,  hung 
back  from  the  manger,  and  touched  neither  gruel  nor  milk.  At  8  o'clock 
the  temperature  was  39*3°  C.  (.1027^  F.),  respirations  ^2,  pulse  54. 
There  was  no  thoracic  dulness,  and  on  auscultation  of  the  lungs  no 
abnormal  sound.  On  examining  the  throat  externall}-  nothing  fresh 
could  be  detected. 

"  On  the  three  following  days  the  condition  slightl}-  improved.  The 
temperature  varied  between  38*6°  and  39°  C.  (101*4^  and  i02'2°  F.)  : 
the  breathing  was  calmer.  The  patient  refused  milk,  but  took  a  little 
gruel,  hay,  and  oats. 

"  On  the  evening  of  the  27th  the  condition  became  aggravated.  The 
temperature  rose  more  than  a  degree.  The  apex-beat  of  the  heart  was 
violent,  and  could  be  heard  on  the  right  side  of  the  chest.  The  small 
quantit}'  of  fctces  passed  was  co\ered  with  blood-stained  mucus.  As 
the  animal  entirel}-  refused  food,  six  quarts  of  milk  were  given  per 
vcctinn.  In  the  e\ening  it  drank  the  liquid  portion  of  its  gruel,  ap- 
peared more  depressed  than  formerl}-,  and  la}-  down  on  its  side.  A 
subcutaneous  injection  of  15  grains  of  caffeine  was  gi\en. 

"  On  the  28th  the  animal  was  standing,  and  seemed  rather  less 
depressed  than  on  the  previous  evening.  It  ate  a  few  mouthfuls  of 
fresh  lucerne.  Swallowing  appeared  easier.  Temperature  39°  C. 
(i02'2°  F.)  ;  respirations  30  ;  pulse  45.  Two  small  abscesses  which 
had  developed  on  the  left  shoulder  were  opened.  Pus  mixed  with 
saliva  ran  from  the  second  submaxillar}-  abscess ;  a  salivary  fistula 
evidently  existed  on  the  left  side.  The  same  evening  the  animal 
readily  took  six  quarts  of  milk.     Temperature  39*2'^  C.  (102*5°  F.). 

"  On  the  morning  of  the  29th  September  the  patient  drank  four 
quarts  of  milk,  but  refused  other  food.  It  showed  difficult}-  in  breath- 
ing ;  expiration  was  double.  Percussion  and  auscultation  revealed 
nothing  new.  The  throat  and  parotid  region  were  insensitive  on 
pressure  ;  the  scapular  muscles  sho^^■ed  slight  twitching  movements. 
The  animal  seemed  unsteady  on  its  front  leg:s,  and  at  times  sat  down 


222  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

like  a  dog.  On  passing  the  catheter  only  a  small  quantity  of  urine  was 
drawn  off.  Temperature  38*9°  C.  (102^  F.)  ;  respirations  39  ;  pulse 
48.  At  midday  temperature  39*3°  C.  (i02'7°  F-)  ;  respirations  46; 
pulse  75.  Breathing  remained  difficult,  and  trembling  of  the  muscles 
attached  to  the  olecranon  was  more  marked.  The  horse  drank  a  little 
gruel  and  then  lay  down  on  its  chest.  It  rose  in  a  few  minutes,  the 
face  assuming  an  anxious  expression,  and  again  sat  down  on  its  hind 
quarters  like  a  dog. 

"  Towards  three  o'clock  it  took  a  few  mouthfuls  of  gruel,  and  once 
more  lay  down.     Ten  minutes  later  it  died  without  a  struggle. 

"  .4  utopsy. — Nothing  in  the  peritoneal  cavity  ;  little  food  in  the  intes- 
tine ;  the  mucous  membrane  of  the  small  intestine  was  congested  in 
places.  The  stomach  contained  a  few  quarts  of  liquid  ;  its  walls  were 
contracted  and  wrinkled.  The  liver  was  large  and  yellowish  brown  in 
colour.  The  kidneys  were  pale  on  section  ;  the  pelvis  of  the  kidney 
contained  a  little  viscous  yellowish  liquid.  With  the  exception  of  a 
small  abscess  in  the  anterior  part  of  the  right  lobe  the  lungs  were 
normal.  The  bronchial  glands  were  slightly  swollen.  Nothing  ab- 
normal in  the  bronchi  or  trachea. 

"The  heart  had  stopped  in  diastole.  The  blood  which  escaped  on 
section  was  liquid  and  blackish,  but  coagulated  rapidly. 

"  The  lower  and  lateral  surfaces  of  the  tongue  showed  several  ecchy- 
mosed  patches,  over  which  the  mucous  membrane  was  denuded  of 
epithelium.  The  epithelium  covering  the  upper  surface  was  at  many 
points  greatly  thickened.  At  the  entrance  to  the  pharynx  were  several 
blind  sacs  (Morgagni's  diverticula)  ;  the  buccal  mucous  membrane 
showed  nothing  unusual. 

"  The  mucous  membrane  of  the  pharynx  was  thickened,  violet  in 
colour,  ulcerated  in  places,  and  covered  with  whitish  spots  indicating 
little  abscesses  developed  in  the  submucous  connective  tissue.  Gentle 
pressure  caused  them  to  discharge  thick  yellowish-white  fcetid  pus. 
The  mucous  membrane  covering  the  anterior  surface  and  base  of  the 
epiglottis  was  also  thickened  and  violet  in  colour.  The  arytaenoid 
cartilages  were  of  similar  appearance.  The  mucous  membrane  of  the 
pharynx  was  in  places  three  eighths  of  an  inch  thick  ;  its  superficial 
layer  was  hyperasmic,  thickened,  and  infiltrated  with  offensive  pus. 
The  subjacent  muscles  were  similarly  thickened,  discoloured,  and 
whitish,  and  contained  numerous  small  abscesses. 

"The  retro-pharyngeal  glands  were  as  large  as  a  hen's  egg,  and 
contained  purulent  centres,  some  of  considerable  size  ;  all  were  filled 
with  whitish  creamy  stinking  pus." 

This    horse,   therefore,   died    of   diffuse    inflammatory    pharyngitis 


A    CASE    OF    PHARYNGITIS    DUE    TO    STRANGLES.  223 

developed  during  strangles.  Among  the  complications  of  this  disease 
pharyngitis  is  one  of  the  commonest  and  least  dangerous.  It  is  indi- 
cated, like  other  forms  of  sore  throat,  by  loss  of  appetite,  discharge 
from  the  nostrils  of  fluid  mixed  with  food  and  of  part  of  the  drinking- 
water,  by  swelling  and  abnormal  sensibility  of  the  throat  region.  In 
pharyngitis  resulting  from  strangles  the  lymphatic  glands  in  the  poste- 
rior portion  of  the  intermaxillary  space  become  inflamed,  causing 
cedematous  swelling,  which  is  soon  followed  by  abscess  formation.  In 
the  majority  of  cases  the  only  surgical  treatment  necessary  is  puncture 
of  the  abscess,  recovery  occurring  in  from  a  fortnight  to  a  month. 

The  grave  forms  of  pharyngitis  due  to  strangles  are  those  in  which 
abscesses  develop  deep  in  the  guttural  region  near  the  subparotid  or 
retro-pharyngeal  lymphatic  glands.  Functional  symptoms  are  then 
more  marked  and  often  alarming,  swelling  of  the  throat  and  of  the 
parotid  region  being  sometimes  enormous.  To  prevent  rapidly  fatal 
complications  the  pus  must,  as  soon  as  possible,  be  evacuated. 

Provided  free  drainage  is  secured,  the  swelling  which  accompanies 
these  abscesses  usually  disappears  rapidly.  U  nless  expectant  treatment 
is  too  long  pursued,  respiration  seldom  becomes  so  embarrassed  as  to 
necessitate  tracheotomy.  In  any  case,  if  dyspnoea  become  intense  and 
the  pus  cannot  be  discovered  even  after  several  exploratory  punctures, 
no  hesitation  need  be  felt  in  operating,  as  in  the  horse  the  method  is 
very  simple,  never  proves  harmful,  gives  immediate  relief,  and  removes 
one  cause  of  aggravation  of  the  pharyngitis. 

[Operation  is  as  follows: — A  twitch  having  been  applied,  and  the 
seat  of  operation  cleansed  and  disinfected,  an  incision  is  made  through 
the  skin  over  the  highest  part  of  the  swelling,  and  if  possible  below  the 
edge  of  the  parotid,  the  underlying  fascia  divided,  and  the  forefinger 
inserted.  The  thick  connective  tissue  or  gland  structure  is  now  broken 
down,  the  free  hand  meanwhile  pressing  on  the  swelling  and  guiding 
the  inserted  finger  towards  the  abscess,  which,  on  being  localised,  is 
broken  by  a  sharp,  powerful  thrust.  A  stream  of  pus  escapes,  often 
spurting  to  a  distance  of  several  yards.  The  opening  may  afterwards 
be  enlarged,  and  a  gauze  or  rubber  drain  inserted. — Jno.  A.  W.  D.] 

In  our  patient  the  pharyngeal  inflammation  was  never  really 
menacing.  We  could  scarcely  discover  any  swelling  or  pain  on  pres- 
sure over  the  throat  region.  The  abscess  beneath  the  jaw  was  the  only 
complication  in  that  neighbourhood. 

The  persistence  of  functional  disturbance  after  the  fifteenth  day, 
and  the  absence  of  local  lesions  capable  of  explaining  it,  caused  me  to 


224  CLINICAL    VKTKRINARY    MEDICINE    AND    SURCIKRV. 

suspect  paral}'sis  of  the  phaiynx.  Even  when  inflammatory  symptoms 
are  relatively  slight  this  paralysis  may  occur,  as  proved  by  man}- 
recorded  cases.  During  February  last  we  had  in  hospital  a  five-year- 
old  mare  in  which  pharyngeal  paralysis  occurred  as  a  complication  of 
benign  strangles.  Cauterisation  in  points — the  treatment  usuall}' 
recommended,  and  the  daily  administration  of  two  and  a  half  to  eight 
drachms  of  potassium  iodide  until  signs  of  iodism  appeared,  gave  no 
beneficial  result  though  twice  repeated.  Nor  did  greater  success  attend 
the  opening  and  washing  out  of  the  guttural  pouches  on  both  sides — 
an  operation  which,  however,  has  sometimes  succeeded,  and  which 
probably  acts  in  a  different  way  from  cauterisation. 

1  thought  of  performing  this  operation  in  the  case  of  the  first  horse. 
but  deferred  interfering,  always  hoping  for  improvement.  In  this 
animal,  however,  opening  the  guttural  pouches  could  only  have  favoured 
rupture  of  the  retro-pharyngeal  abscesses.  Even  supposing  this  had 
occurred  we  should  not  have  saved  our  patient.  The  gravest  lesions — 
those  which  proved  fatal — occurred  in  the  walls  of  the  pharynx  itself, 
and  in  regard  to  them  we  could  do  nothing  energetic  or  directly  bene- 
ficial. 

Nevertheless  I  have  no  hesitation  in  giving  the  following  advice  : 
If   in    pharyngeal   paralysis   resulting  from    strangles,    or   from   in- 
flammatory sore  throat  of  any  character,  the  classical  treatment  fail, 
one  should  before  giving  up  the  case  as  hopeless  suggest  opening  the 
guttural  pouches — ^hyovertebrotomy. 


XXXL— TUBERCULOSIS    IN    THE    HORSE. 

During  the  past  week  an  eight-year-old  Norman  gelding  was 
brought  for  examination  with  the  history  that  six  months  before  it  had 
suffered  from  "inflammation  of  the  lungs,"  from  which  it  seemed  to 
recover,  but  that  at  the  commencement  of  last  month  it  had  again 
fallen  ill  without  any  apparent  cause.  Its  condition  gradually  became 
aggravated  in  spite  of  treatment. 

The  animal  was  extremely  thin,  and  its  general  condition  suggested 
a  wasting  disease.  Breathing  was  not  very  rapid,  but  appeared  painful. 
I  was  only  able  to  make  a  partial  examination,  but  exploration  of  the 
chest  having  revealed  extensive  diffuse  changes  in  both  pulmonary 
lobes,  I  mentioned  to  you  that  this  discovery,  together  with  the  chronic 
character  of  the  disease  and  the  debilitated  condition  of  the  animal, 
aroused  suspicion  of  tuberculosis. 

The  patient  was  left  in  hospital.  One  of  you  made  a  note  during 
the  evening  of  the  principal  symptoms  which  it  presented.  I  may 
briefly  recapitulate  them, 

"  The  mucous  membrane  of  the  mouth  is  pale  and  cold  to  the 
touch,  as  are  the  trunk  and  limbs.  The  conjunctiva  is  whitish  and 
slightly  infiltrated  ;  the  pulse  from  50  to  55  per  minute,  small  and 
irregular ;  the  respiration  20  per  minute,  accelerated,  painful,  and 
interrupted.  On  auscultating  the  lung  the  respiratory  murmur  is 
diminished  in  the  lower  portion  of  both  lobes.  In  the  middle  portion, 
crepitant,  sibilant,  and  cavernous  rales  are  heard,  and  in  the  upper  an 
increased  vesicular  murmur.  On  percussion  the  upper  and  middle 
zones  are  normally  resonant,  but  the  lower  is  partially  dull.  Palpation 
of  the  abdomen  and  rectal  exploration  reveal  nothing  abnormal.  The 
anterior  part  of  the  sternal  region  is  oedematous.  Urine  is  passed 
frequently  and  in  large  quantities,  saturating  the  litter  and  giving  off 
a  strong  odour.     The  patient  has  taken  a  part  of  its  food." 

I  purposed  testing  this  horse  with  tuberculin,  but  it  died  during 
the  night. 

Autopsy. — "In  the  abdominal  cavity  the  kidneys  and  supra-renal 

p 


226  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

capsules  are  the  only  organs  which  have  undergone  change.  On 
incising  the  former,  tubercles  appeared  scattered  throughout  both 
portions  of  the  parench3^ma.  The  supra-renal  capsules  are  hyper- 
trophied,  and  show  on  section  several  little  yellowish  softened 
tubercles,  the  pus  from  which  contains  bacilli.  In  the  anterior  portion 
of  the  sublumbar  region,  and  adherent  to  the  diaphragm,  is  a 
lymphatic  gland  as  large  as  a  walnut,  the  centre  purulent. 

"  In  the  thoracic  cavity  disease  is  marked.  Both  lungs  are  large, 
dense,  and  firm  to  the  touch  ;  their  surface  is  dotted  over  with  greyish- 
white  points  and  little  patches.  Palpation  reveals  hardened  granules 
and  a  few  small  areas  of  fibrous  consistence  in  the  superficial  layers. 

"  Vertical  sections  have  a  very  diversified  appearance,  depending  on 
the  part  of  the  lobe  examined.  The  anterior  part  of  both  lobes  shows 
fine  greyish  granules,  varying  in  size  between  a  grain  of  sand  and  a 
millet  s.eed  ;  at  certain  points  these  become  confluent,  forming  narrow 
lines  or  slender  irregular  bands  of  lighter  colour,  which  stand  out 
prominently  against  the  deeper  tint  of  the  adjacent  unchanged  tissue, 
where  the  vessels  are  simply  engorged  with  blood.  No  softened 
centres  are  seen  in  these  preliminarj'  sections.  Towards  the  base,  and 
in  the  upper  third  of  the  lobes,  a  few  small  areas  remain  in  which  the 
lung  has  preserved  its  physiological  characters.  Sections  through 
these  are  of  similar  aspect  to  the  preceding.  In  other  regions  they 
show  very  numerous  unsoftened  miliary  tubercles,  at  many  points 
confluent,  at  others  separated  by  hepatised  or  indurated  pulmonary 
tissue.  Certain  sections  which  appear  greyish,  and  of  the  same  firm 
consistence  as  in  chronic  pneumonia,  contain  enormous  numbers  of 
whitish  or  yellowish  granules,  masses  of  broken-down  tubercles  and 
irregular  cavernous  spaces,  varying  in  size  up  to  two  inches  in  diameter, 
containing  pus  rich  in  bacilli :  the  walls  of  several  of  these  cavernous 
spaces  are  lined  by  a  kind  of  yellowish  diphtheroid  exudate.  Other 
sections  again  show  irregular  greenish-grey  patches,  indicating  frag- 
ments of  necrotic  tissue.  In  most  of  the  large  bronchi  the  mucous 
membrane  is  inflamed  and  thickened. 

"  The  right  bronchial  glands  form  a  number  of  swellings  the  size  of 
an  almond.  The  left  are  fused  together  into  an  egg-sized  mass,  the 
centre  of  which  contains  a  cavity  filled  with  viscous,  greenish -yellow  pus. 
"  Immediately  in  front  of  the  diaphragm,  beneath  the  vertebral 
column,  are  several  hypertrophied  glands  the  size  of  hazel-nuts,  with 
purulent  centres.  In  the  posterior  mediastinum  the  supra-oesophageal 
gland  is  also  swollen  and  has  undergone  suppuration  ;  the  chain  of 
oesophageal  glands  and  the  lymphatic  vessels  connecting  them  are 
hardened." 


■■'.>■  V  -'tis 


Tuberculous  infiltration  of  the  lung.  Section  of  the  right  lobe. 


tubp:rculosis  in  the  horse.  227 

In  the  horse,  as  in  other  species  of  animals,  tuberculous  changes 
are  sometimes  generalised,  sometimes — and  most  frequently — localised 
in  the  thoracic  or  abdominal  viscera.  Analysis  of  the  cases  published 
in  France  and  other  countries  shows  that  the  organs  may  be  arranged 
in  the  following  order  with  regard  to  the  relative  frequence  with  which 
they  are  affected  : — lungs,  bronchial  glands,  mesenteric  and  sub- 
lumbar  glands,  mediastinal  glands,  spleen,  liver,  pleura,  peritoneum, 
intestine.  The  proportion  of  cases  of  pulmonary  tuberculosis  is  about 
70  per  cent.  ;  of  tuberculosis  of  the  mesenteric  and  sublumbar  glands 
and  of  the  spleen  about  40  per  cent.  ;  of  the  liver,  pleura,  and  perito- 
neum 20  per  cent.  ;  of  the  intestine  15  per  cent.  Pleurisy  has  been 
noted  in  about  a  fifth  of  the  cases.     Ascites  is  more  rare. 

Tuberculosis  of  the  kidney,  though  common  in  certain  species, 
especially  in  the  dog,  appears  to  be  exceptional  in  the  horse.  The 
pericardium,  heart,  bones,  muscles,  and  other  tissues  are  rarely  affected. 
I  have  seen  only  two  cases  of  tuberculosis  of  the  endocardium,  two  of 
the  pericardium,  two  of  the  bones,  and  one  of  the  mammar}'  gland.  In 
one  of  his  reported  cases  Mauri  mentions  tuberculous  lesions  of  the 
pharyngeal  glands,  of  the  pharyngo-tracheal  mucous  membrane,  and 
of  the  endocardium.  Wolstenholme  claims  to  have  seen  several  cases 
of  tuberculosis  of  the  brain,  but  without  furnishing  any  proof  that  the 
lesions  were  really  due  to  tubercle  bacilli.  In  one  case  showing  pulmo- 
nary lesions  and  cavernous  spaces,  ossification  of  the  right  auricle  of 
the  heart  was  noted. 

The  changes  in  the  thoracic  organs,  and  especially  in  the  lung,  do 
not  always  present  the  characters  found  in  our  patient.  Sometimes 
the  pulmonary  lobes  are  crammed  with  recent  miliary  granules,  such  as 
may  be  seen  in  the  other  specimen.  These  granules  are  whitish  or 
yellowish  in  colour,  dense,  hard,  and  without  central  softening ;  they 
are  dispersed  throughout  the  entire  lung,  isolated  in  most  instances, 
confluent  in  a  certain  number,  but  always  firm  and  unsoftened.  In 
general,  the  parenchyma  of  the  lung  in  which  they  are  embedded  is  of 
normal  colour  and  consistence. 

In  other  cases  tubercles  have  developed  in  considerable  numbers 
in  the  connective  tissue  of  the  lung  without  producing  signs  of  acute 
inflammation.  Here  is  a  specimen  of  such  tubercular  infiltration. 
The  surface  of  sections  appears  almost  entirely  covered  with  whitish, 
very  dense  masses  of  tubercle,  irregular  in  outline,  united  by  bands  of 
the  same  appearance  and  nature  which  run  in  all  directions,  inter- 
twining and  enclosing  portions  of  apparently  healthy  or  slightly  hyper- 
aemic  parenchyma.  You  will  note  that  such  lesions  are  particularly 
large  towards  the  upper  part  of  the  lung.     On  bacteriological  examina- 


2  28  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

tion  we  found  very  few  bacilli,  whether  the  rubbings  or  sections  were 
treated  by  Ehrlich's,  ZiehPs,  or  Kiihne's  methods.  In  this  form,  and 
in  the  preceding,  the  two  pulmonary  lobes  may  weigh  as  much  as 
eighty-eight  pounds  or  even  more. 

Finally  the  lung  sometimes  exhibits  lesions  which  to  the  naked  eye 
resemble  sarcomata.  Here  are  sections  of  lung  from  a  twelve-year-old 
horse  slaughtered  during  the  surgical  exercises,  in  which  you  may 
observe  this  form  of  lesion.  Both  lungs  were  at  points  bosselated, 
and  quite  deformed  by  spherical  tumours,  developed  more  especially 
towards  their  upper  border.  Five  of  these,  three  in  the  right  and  two 
in  the  left  lobe,  were  as  large  as  a  man's  fist,  appearing  externally  as 
large  hemispherical  projections.  Regularly  rounded  in  outline  and 
easily  separable  from  the  surrounding  tissues,  these  swellings  were 
built  up  of  little  globular  masses,  pale  grey  or  slightly  yellowish  on 
section,  with  a  few  softened  centres.  At  points,  and  especially  towards 
the  periphery  of  the  lung,  these  growths  were  separated  by  bands  or 
tracts  of  whitish  fibrous  tissue,  denser  and  firmer  than  the  substance 
of  the  lobules.  The  growths  were  surrounded  by  a  thin  fibrous  layer  ; 
their  surroundings  showed  no  signs  of  acute  inflammation,  or  sclerosis, 
the  pulmonary  tissue  immediately  encircling  them  being  of  normal 
appearance,  except  at  a  few  points  where  tubercles  varying  in  size 
between  a  hemp-seed  and  a  small  nut  were  found.  One,  however,  was 
surrounded  by  a  layer  of  pulmonary  tissue,  between  |  and  f  of  an 
inch  thick,  infiltrated  with  granules.  Of  these  medium  and  small- 
sized  masses  some  showed  the  same  microscopic  appearances  as  the 
preceding,  others  were  dotted  with  yellowish  points  indicating  softened 
granules,  while  still  others  were  marked  with  little  brownish,  irregular 
spots ;  all  were  remarkably  rich  in  giant-cells,  but  scarcely  contained 
more  bacilli  than  the  larger  growths.  Bacilli,  in  fact,  were  only  found 
in  a  proportion  of  the  sections. 

The  tracheo-bronchial  lymphatic  glands  sometimes  form  very  large, 
•dense,  firm  swellings  of  uniform  fibrous  consistence,  or  softened, 
caseous,  or  partially  calcified  growths,  embracing  the  terminal  portion 
of  the  trachea  and  neighbourhood  of  the  bronchi.  In  exceptional 
instances  such  lesions  may  be  found  at  the  post-mortem  of  animals  with 
healthy  lungs.     Nielsen  has  related  a  curious  case  of  this  nature. 

Tuberculosis  of  serous  membranes  is  less  common  than  in  the  ox. 
It  exhibits  the  same  naked-eye  appearances  and  very  nearly  the  same 
microscopic  characters  as  in  the  bovine  species ;  sometimes  granules 
and  tubercles  are  found  in  large  numbers  with  or  without  a  greyish  or 


i 


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?^.: 


fer 


4.' 


Sarcomatous  form  of  pulmonary  tuberculosis.  Section  through  the  left  lobe  of  the  lun; 


TUBERCULOSIS    IN    THE    HORSE.  229 

sanguinolent  exudate.  It  is  usually  confined  to  the  pleura  or  perito- 
neum. Lesions  of  the  pericardium,  endocardium,  and  meninges  are  rare. 

In  that  form  of  tuberculosis  known  as  abdominal  the  sublumbar 
lymphatic  glands  are  transformed  into  enormous  bosselated  swellings 
covering  the  terminal  portion  of  the  aorta  and  origin  of  its  branches, 
and  sometimes  occupying  the  entire  subvertebral  groove  from  the 
diaphragm  to  the  pelvis.  These  swellings  are  superficially  of  uniform 
consistence,  but  on  section  often  show  caseous  or  even  calcified  centres. 
Their  weight  may  even  exceed  65  lbs.  The  mesenteric  glands  are  more 
or  less  hypertrophied  and  caseous,  or  partly  calcified.  The  intestine 
may  exhibit  ulcerations  or  tubercles.  The  liver  and  spleen  are  always 
larger  than  normal,  and  may  either  be  crowded  with  fine  granules  or 
bosselated,  covered  with  whitish  swellings  varying  in  size  between  a 
hazel-nut  and  a  child's  head,  uniformly  dense,  of  the  consistence  of 
sarcoma,  or  partially  calcified,  especially  in  the  case  of  the  spleen.  The 
common  form  of  tuberculosis  of  the  spleen  can  only  be  differentiated 
from  sarcoma  and  lymphadenoma  by  microscopical  examination  and 
inoculation.  In  cases  of  old  standing  and  extensive  abdominal  lesions 
the  lungs  usually  contained  large  numbers  of  granules  and  tubercles.* 

The  statement  of  certain  authors  that  calcification  is  not  seen  in 
tuberculous  lesions  in  the  horse  is  incorrect.  This  change  has  really 
been  mentioned  in  a  number  of  instances.  I  may  add  that  athero- 
matous degeneration  and  calcification  of  the  walls  of  the  common  and 
posterior  aortae  are  fairly  frequent  in  tuberculous  horses. 

When  infection  has  occurred  by  the  respiratory  passages  lesions 
maybe  confined  to  thoracic  organs  like  the  lung,  tracheo-bronchial  and 
mediastinal  glands,  pleura,  and  pericardium,  but  usually  the  abdominal 
viscera,  especially  the  mesenteric  glands  and  spleen,  are  simultaneously 
affected.  When  the  bacilli  have  penetrated  by  the  intestine  the  abdo- 
minal organs,  and  particularly  the  mesenteric  glands,  liver,  spleen,  and 
peritoneum — sometimes  even  the  intestine — show  older  and  usually 
more  extensive  lesions  than  are  met  with  in  the  thoracic  cavity.  Iden- 
tification of  the  point  of  entry  of  the  virus  is  not  always  so  easy  a 
matter  as  one  might  be  led  to  believe.  It  is  principally  based  on  the 
size  and  age  of  the  lesions  in  the  abdominal  and  thoracic  organs 
respectively,  and  on  the  existence  or  absence  of  centres  of  degeneration. 
When  recent  pulmonary  tuberculosis  is  accompanied  by  extensive  and 
old-standing  changes  in  the  abdominal  viscera,  the  virus  has  certainly 
entered  by  the  intestine  ;  but  when  the  pulmonary  lesions  are  of  old 

''  Bacteriological  and  experimental  investigations  have  led  M.  Nocard  to  conclude  that 
the  pulmonary  form  of  equine  tuberculosis  resembles  human  tuberculosis,  and  the  abdominal 
form  avian  tuberculosis. 


236  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

standing,  and  contain  degenerative  centres  like  those  in  the  abdomen,  it 
becomes  difficult  to  decide  whether  they  are  primary  or  secondary. 

The  development  of  equine  tuberculosis  is  usually  slow,  insidious, 
and  accompanied  only  by  disturbance  common  to  a  number  of  visceral 
diseases.  The  first  indications  consist  in  gradually  increasing  weak- 
ness, signs  of  fatigue,  perspiration  after  slight  exertion,  capricious  or 
diminished  appetite,  febrile  attacks,  and  lastly  wasting. 

When  the  lung  is  invaded  to  a  certain  degree,  signs  of  chronic 
broncho-pneumonia  or  broken  wind  may  occur ;  the  animal  shows 
paroxysms  of  coughing,  dyspnoea,  acceleration  of  the  respiratory  move- 
ments, with  a  double,  jerky,  expiratory  effort,  and  a  mucous  or  muco- 
purulent discharge,  sometimes  foetid  or  streaked  with  blood.  On 
auscultation  the  vesicular  murmur  is  usually  audible  over  the  entire 
area  of  both  lobes,  sometimes  diminished,  sometimes  locally  increased  ; 
crepitant  or  sibilant  rales  may  be  heard,  but  the  tubal  murmur  is  rare. 
The  parts  continue  resonant  on  percussion,  though  small  areas  may 
appear  partially  or  completely  dull.  At  a  later  stage  the  swelling 
formed  by  the  enlarged  tracheo-bronchial  glands  may  in  some  animals 
be  seen  at  the  entrance  of  the  thorax  and  on  the  sides  of  the  trachea. 
Pulmonary  tuberculosis  of  rapid  development  may  at  first  sight  give 
the  impression  of  pneumonia,  or,  if  accompanied  by  pleural  exudate,  of 
pleuro-pneumonia. 

The  existence  of  abdominal  tuberculosis  is  often  scarcely  suspected 
until  the  moment  of  death.  In  occasional  instances  visceral  lesions 
may  produce  colic  ;  or  those  of  the  intestine  cause  chronic  enteritis 
with  profuse  diarrhoea,  the  fluid  being  blood-stained  when  the  mucous 
membrane  is  ulcerated.  When  the  disease  is  suspected  rectal  explora- 
tion very  often  reveals  the  presence  of  sublumbar  swellings. 

Specific  glandular  enlargement  may  appear  externally  in  various 
regions,  especially  in  the  submaxillary  space  and  in  front  of  the  chest. 
Those  in  the  submaxillary  space  have  often  been  mistaken  for  glanderous 
lesions.  Ehrhardt  followed  the  progress  of  a  case  which  commenced 
with  symptoms  of  sore  throat  and  swelling  of  the  submaxillary  glands. 
For  a  time  he  suspected  the  animal  of  glanders,  but  three  years  later 
it  died  from  generalised  tuberculosis.  In  a  horse  mentioned  by  Johne 
a  swelling  resembling  a  cold  abscess  appeared  in  front  of  the  chest, 
over  the  seat  of  the  prepectoral  glands,  and  was  removed.  The  wound 
refused  to  heal.  Shortly  afterwards  emaciation  set  in,  the  animal 
appeared  feeble,  and  the  symptoms  seemed  to  point  to  lesions  in  the 
lungs  and  abdominal  viscera.  The  nature  of  the  disease  was  not 
recognised  until  post-mortem  examination.     Robert  published  an  almost 


TUBERCULOSIS    IN    THE    HORSE.  23 1 

similar  case.  Multiple  and  bilateral  swelling  of  lymphatic  glands  may 
at  first  glance  suggest  lymphangitis. 

At  a  varying  but  usually  late  stage  in  the  disease  most  patients 
show  abundant  polyuria,  followed  by  rapid  wasting,  a  fact  to  which 
M.  Nocard  called  attention  ten  years  ago  in  an  "  Etude  clinique  de  la 
Phthisic  tuberculeuse  du  Cheval."  The  urine  contains  large  quanti- 
ties of  urea  and  uric  acid. 

In  the  horse  tuberculosis  usually  follows  a  very  slow  course,  certain 
patients  continuing  work  for  months,  or  even  years,  and  showing  little 
tendency  to  emaciation  or  to  febrile  attacks.  The  changes  may  long 
remain  localised  in  the  abdominal  glands,  but  finally  the  subjects 
either  become  very  feeble  or  the  bacilli  enter  the  venous  circulation, 
causing  general  infection.  Febrile  symptoms  are  then  seen.  The  tempe- 
rature rises  to  40°  C.  or  40-5°  C.  (104°  F.  or  104*9°  F-)>  and  wasting 
makes  rapid  strides.      Sometimes  the  hind  limbs  become  swollen. 

In  the  horse  tuberculosis  may  also  assume  unusual  forms,  liable  to 
be  mistaken  for  other  diseases,  which  differ  so  widely  from  classical 
types  as  not  even  to  suggest  the  idea  of  tuberculous  infection.  I  will 
describe  two  cases  from  my  own  clinique. 

The  first  was  that  of  an  eight-year-old  horse  brought  for  examina- 
tion in  April,  i88g,  by  a  contractor  who  had  bought  it  three  years 
before.  Different  points  on  the  surface  of  the  body  showed  indolent 
tumours  of  fibrous  consistence  and  varying  size,  the  largest  about  the 
diameter  of  a  two-shilling  piece  and  the  thickness  of  a  man's  little 
finger.  Some  had  developed  in  the  skin,  others  in  the  subcutaneous 
connective  tissue ;  both  varieties  were  accompanied  by  disease  of 
lymphatic  glands.  At  certain  points  the  largest  swellings  were  con- 
nected with  neighbouring  lymphatic  glands  by  corded  lymph  vessels. 

The  patient  was  left  here  for  more  thorough  examination.  Rectal 
exploration  revealed  nothing.  The  temperature  oscillated  between 
39°  C.  and  39'5°  C.  (102*2°  F.  and  103*1°  F.).  The  urine  was  of 
normal  amount,  but  slightly  albuminous.  The  proportion  of  red  and 
white  blood-corpuscles  was  normal.  One  of  the  subcutaneous  swellings 
was  excised  for  histological  study.  Its  structure  was  that  of  a  sarcoma. 
The  horse  was  removed  home  and  put  to  work,  but  grew  more  and 
more  feeble.  At  a  trot  its  breathing  became  steadily  aggravated,  and 
a  loud  roaring  sound  was  produced.  Certain  tumours  diminished  and 
disappeared,  but  many  others  developed.  Having  become  incapable 
of  work  the  animal  was  slaughtered.  On  post-mortem  examination  we 
found  numerous  swellings  in  the  skin  and  subcutaneous  connective 
tissue,  together  with  neoplastic  and  sclerosing  infiltration  of  certain 


232  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 

groups  of  muscles,  especially  of  the  adductors  of  the  hind  limbs  and 
superficial  gluteal  muscles  ;  nodules  in  the  liver  and  spleen,  and  hyper- 
trophy of  the  sublumbar  lymphatic  glands.  Bacteriological  examina- 
tion showed  these  lesions  to  be  of  tuberculous  origin,  though  bacilli 
were  very  scanty. 

Up  to  the  present  time  only  two  cases  of  dermic  and  hypodermic 
tuberculosis  in  the  horse  have  been  published.  Excluding  the  lymphan- 
gitis and  inflammation  of  lymphatic  glands,  the  symptoms  are  those  of 
subcutaneous  sarcoma — a  disease  which  formed  the  subject  of  a  previous 
lecture,  but  is  also  very  rare. 

The  case  I  am  about  to  mention  is  exceedingly  instructive  from  the 
clinical  point  of  view.     It  is  shortly  as  follows. 

At  the  commencement  of  May  last  we  received  into  hospital  a  very 
well  nourished  seven-year-old  entire  horse,  bought  in  1894,  which  had 
done  excellent  service  for  nearly  two  years,  viz.  until  February,  i8g6. 
It  had  simply  shown  swelling  of  the  scrotum.  As,  however,  the 
swelling  increased  in  size  until  finally  it  interfered  with  the  action  of 
the  hind  limbs,  the  animal  was  brought  here  to  be  castrated. 

On  examination  we  detected  chronic  inflammation  of  the  right 
testicle  and  its  envelopes.  The  animal  not  having  reacted  to  mallein, 
castration  was  performed.  The  testicle,  enlarged  to  three  times  its 
normal  dimensions,  was  removed  with  the  ecraseur  ;  its  parenchyma 
had  undergone  httle  change;  the  head  of  the  epididymis  was  as  large 
as  an  orange,  its  tissue  whitish  and  sclerosed  ;  the  cord  was  healthy, 
except  that  its  serous  covering  was  dotted  over  with  reddish  granula- 
tions varying  in  size  between  that  of  a  millet  seed  and  a  small  pea. 
These  granulations  were  regarded  as  innocent  inflammatory  products. 
Considerable  swelling  occurred  round  the  wound,  but  soon  became 
absorbed,  and  the  wound  itself  appeared  to  heal  regularly. 

At  the  owner's  request  the  other  testicle  was  removed  fifteen  days 
after  the  first  operation,  the  ecraseur  again  being  employed.  It  was 
about  one  third  larger  than  normal,  the  vaginal  tunic  contained  a  little 
lemon-coloured  liquid,  the  cord  was  slightly  swollen,  and  its  serous 
covering  partly  dotted  over  with  granulations  like  those  seen  on  the 
former  occasion. 

During  the  following  days  the  general  condition  and  appetite  were 
good.  Nevertheless  fever  was  marked,  the  temperature  rising  nearly 
to  40°  C.  (104°  F.).  The  scrotal  swelling  was  large.  This  condition 
persisted  for  a  week  without  any  appreciable  change  except  that  the 
animal  became  rather  thinner.  One  morning,  however,  the  horse  was 
found  dead  in  its  stall.  On  the  previous  evening  it  had  eaten  all  its 
food,  and  the  student  in  charge  had  noted  nothing  alarming. 


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Tuberculous  endocarditis  in  the  horse.  Left  ventricle. 


TUBERCULOSIS    IN    THE    HORSE,  233 

On  post-mortem  examination  it  became  clear  that  the  horse  had  died 
from  tuberculosis.  The  spermatic  cords  were  swollen,  indurated,  and 
covered  with  granulations.  The  liver,  spleen,  lungs,  sublumbar  and 
bronchial  glands,  peritoneum,  pleura,  and  pericardium  all  contained 
numerous  tubercles.  The  intestinal  mucous  membrane,  and  especially 
that  of  the  large  colon,  was  crowded  with  ulcerations,  most  of  which 
were  very  rich  in  bacilli.  The  heart  showed  remarkable  changes. 
Large  tracts  of  the  endocardium  of  the  left  ventricle  were  thickened, 
wrinkled,  and  contracted.  Histological  and  bacteriological  examina- 
tion revealed  the  presence  in  it  of  tuberculous  follicles  containing  very 
few  bacilli.  Situated  slightly  below  the  aortic  orifice  in  the  muscular 
tissue  of  the  heart  was  a  tuberculous  abscess  as  large  as  a  hazel-nut,  the 
pus  from  which  contained  numerous  bacilli. 

A  dog,  a  rabbit,  two  guinea-pigs,  and  two  fowls  were  intra-peri- 
toneally  inoculated  with  an  emulsion  prepared  by  crushing  a  fragment 
from  a  sublumbar  lymphatic  gland  and  a  tuberculous  growth  from  the 
gastro-colic  omentum  in  a  little  sterilised  water.  The  dog,  rabbit,  and 
guinea-pigs  became  tuberculous,  the  fowls  resisted. 

Bearing  in  mind  the  varying  forms  which  tuberculosis  may  assume 
in  the  horse,  it  is  rare  that  some  of  the  complex  assemblage  of 
symptoms  fails  to  suggest  the  correct  diagnosis.  The  final  conclusion 
is  assisted  by  auscultation,  percussion,  rectal  exploration,  and  palpation 
of  accessible  lymphatic  glands,  and  is  confirmed  by  bacteriological 
examination,  injection  with  tuberculin,  or  inoculation. 

The  clinical  signs  suffice  to  differentiate  tuberculous  inflammation 
of  lymphatic  glands  from  the  simple  form  (adenitis)  ;  in  the  latter  the 
swellings  are  always  numerous,  generalised,  bilateral,  and  nearly 
uniform  in  each  of  a  pair  of  glands. 

Injection  of  30  centigrammes  of  tuberculin  is  followed  in  tuberculous 
horses  by  a  reaction,  which  usually  attains  its  maximum  about  the 
fifteenth  hour,  the  temperature  rising  2  to  3  degrees  C.  In  the  stable 
attached  to  the  surgical  clinique  you  have  seen  a  horse  retained  for 
experiments  which  developed  tuberculosis  after  a  double  intra-peri- 
toneal  and  subcutaneous  injection  of  tuberculous  material  from  a  dog. 
After  the  lapse  of  more  than  a  year  tuberculin  still  produces  a  febrile 
reaction  of  i  to  2*5  degrees  C. 

At  the  present  moment  there  is  no  treatment  for  tuberculosis  in 
large  animals :  diagnosis  is  followed  by  slaughter.  The  veterinary 
surgeon's  function  is  limited  to  recognising  the  clinical  forms  and  the 
anatomical  and  pathological  appearances. 


XXXII.— TUBERCULOSIS    IN    THE    DOG. 

Among  the  canine  patients  received  into  hospital  during  the  past 
week  two  were  entered  as  suffering  from  tuberculosis.  Both  were 
suffering  from  pulmonary  lesions,  and  were  capable  of  spreading  the 
tuberculous  poison  throughout  the  places  where  they  lived. 

I  will  recall  the  history  of  the  first.  This  was  a  fine  two-year-old 
poodle,  which  was  in  the  habit  of  accompanying  its  master  each  evening 
to  the  tavern,  where  a  prolonged  stay  was  often  made.  About  three 
months  ago  this  dog  was  noticed  to  leave  portions  of  its  food,  to  suffer 
from  cough,  and  to  be  wasting.  It  was  unsuccessfully  treated  with 
various  tonic  preparations.  One  morning,  after  having  followed  its 
master,  who  was  riding  a  bicycle,  it  returned  home,  lay  down,  and 
refused  food.  Next  day  it  still  refused  food,  and  would  not  leave  its 
kennel.     The  day  after  it  was  brought  to  the  College. 

It  was  exceedingly  dull  and  already  much  emaciated ;  the  temporal 
muscles  were  wasted  ;  the  respiration  was  rapid  and  discordant ;  on 
percussion  the  entire  lower  half  of  both  sides  of  the  chest  was  dull. 
The  chest  was  tapped  on  the  right  side,  and  a  greyish  turbid  fluid 
drawn  off,  in  which  bacteriological  examination  failed  to  discover 
bacilli.  But  the  thin  bodily  condition  and  the  pleurisy  left  little  doubt 
regarding  diagnosis  :  the  dog  was  tuberculous.  The  owner  consented 
to  leave  it  in  hospital.  The  temperature  was  39'8°  C.  (i03"6°  F.), 
nevertheless  I  injected  lo  centigrammes  of  tuberculin  ;  it  produced  a 
reaction  of  three  tenths  of  a  degree  C.  ("5°  P.).  During  the  next  two 
days  the  temperature  showed  slight  variations  around  39"5°  C.  (103*1° 
F.),  the  respiration  steadily  becoming  quicker  and  more  difficult.  In 
spite  of  a  fresh  tapping  operation,  in  which  more  than  one  and  three- 
quarter  pints  of  fluid  were  withdrawn,  the  condition  continued  to 
grow  more  serious,  and  death  resulted  forty-eight  hours  later. 

We  found  no  tuberculous  lesion  in  the  abdomen.  The  chest 
cavity,  however,  still  contained  a  certain  quantity  of  greyish  turbid 
liquid    holding    in    suspension    opaque    particles.      The    pleura    was 


TUBERCULOSIS    IN    THE    DOG.  235 

thickened,  showed  rounded  elevations  at  certain  points,  granulations 
and  tubercles  at  others.  The  mediastinum  and  its  lymphatic  glands 
were  enlarged.  Opposite  the  division  between  the  diaphragmatic  and 
cardiac  lobes  of  the  left  lung  was  a  small  ulcerous  wound  due  to  the 
opening  of  a  cavernous  space.  The  diaphragmatic  lobe  contained  an 
inflammatory  centre  as  large  as  a  nut,  the  central  portion  of  which  had 
broken  down  and  was  full  of  greenish-grey  pus  ;  around  it  the  pul- 
monary tissue  was  dotted  with  little  purulent  centres.  The  right  lung 
showed  a  few  cicatricial  patches,  and  its  surface  was  adherent  to  the 
parietal  pleura  at  several  points.  Bacteriological  examination  revealed 
numerous  bacilli  in  the  pus  from  the  cavernous  space. 

Our  second  patient  was  a  three-year-old  sheep-dog  bought  at  the 
age  of  six  months  by  its  present  owner.  It  was  allowed  to  run  about 
freely  in  a  restaurant  patronised  chiefly  by  workmen  and  shop  assistants, 
and  was  in  the  habit  of  turning  over  the  scraps  of  food  from  the  plates 
and  the  heaps  of  rubbish.  Six  weeks  before,  the  animal  lost  its 
appetite.  From  this  time  it  became  markedly  thinner,  and  when 
examined  could  scarcely  stand  upright.  The  face  suggested  extreme 
depression ;  the  eye  was  retracted  within  the  orbit ;  the  temporal  and 
all  the  usually  prominent  muscles  were  wasted  ;  the  skin  was  dry  and 
adherent  to  the  subjacent  tissues.  Respiration  was  rapid  and  painful, 
and  during  expiration  a  portion  of  the  air  escaped  from  between  the 
lips.  On  auscultating  the  chest  crepitant  and  mucous  rales  were  noted 
on  either  side.  The  percussion  sound  was  partially  dull.  There  was 
no  discharge  from  the  nostrils. 

Suspecting  tuberculosis,  we  insisted  on  the  animal  being  left  in 
hospital  for  observation. 

The  day  afterwards  we  administered  a  dose  of  tuberculin ;  the 
temperature  was  38*1°  C.  (ioo"5°  F.)  before  injection,  and  five  hours 
afterwards  rose  to  39*3°  C.  (1027°  F.).  Tuberculin  had  therefore 
produced  fever  to  the  extent  of  1-2°  C.  (2*4°  F.).  Three  days  later  the 
animal  was  killed  at  the  owner's  request. 

On  post-mortem  examination  we  found  the  mesentery  covered  with 
myriads  of  little  tubercles  between  the  sizes  of  a  grain  of  millet  and  a 
pea.  The  mesenteric  glands  were  slightly  enlarged.  The  liver  was 
increased  in  size  and  infiltrated  with  tubercles  of  all  dimensions. 

In  the  thoracic  cavity  the  pleura  was  covered  with  granulations 
and  tubercles.  The  mediastinum  was  greatly  thickened,  and  appeared 
bosselated  in  consequence  of  disease  of  the  lymphatic  glands.  The 
lungs  contained  numerous  tubercles  and  some  cavernous  spaces  filled 
with  fluid  rich  in  bacilli. 


236  CLINICAL    VETERINARY    INffiDICINE    AND    SURGERY. 

I  have  often  mentioned  canine  tuberculosis,  its  different  forms, 
the  symptoms  which  it  produces,  and  the  pecuHarities  seen  in  certain 
patients.  Furthermore,  I  have  shown  you  that  the  disease  may  easily 
be  mistaken  even  on  post-mortem  examination.  As  this  morning 
occasion  has  again  arisen  for  speaking  of  the  disease,  I  will  cast  a  rapid 
glance  over  the  cases  I  have  collected,  and  briefly  describe  some  which 
deserve  remembrance. 

Before  Villemin  published  his  experiments,  the  existence  of  tubercu- 
losis in  the  dog,  though  described  by  some  authors,  was  still  contested 
by  most.  The  discovery  that  the  disease  was  inoculable,  and  the  later 
identification  of  the  bacillus  which  produced  it,  showed  that  the  dog 
was  subject  to  tuberculosis,  and  allowed  of  distinguishing  this  infection 
from  other  morbid  processes  anatomically  characterised  by  lesions  of  a 
tubercle-like  character. 

During  a  further  period  of  nearly  ten  years — until  1891 — -canine 
tuberculosis  was  usually  regarded  as  exceptionally  rare.  This  opinion 
was  founded  on  the  few  cases  published  in  France  and  abroad  previous 
to  the  latter  date,  despite  the  new  power  of  confirming  diagnosis, 
either  during  the  patient's  life  or  after  death. 

During  i8gi  I  turned  my  attention  to  this  form  of  tuberculosis.  1 
looked  for  it  at  Alfort  in  patients  in  my  own  portion  of  the  hospital 
and  among  those  brought  for  consultation.  I  was  soon  convinced  that 
it  could  not  be  considered  rare,  and  that  the  reason  for  its  continuing 
to  be  so  regarded  was  because  observers  failed  to  differentiate  it, 
because  its  pulmonary  localisations  were  mistaken  for  chronic  pneu- 
monia, and  its  other  lesions — especially  those  in  the  liver,  serous  mem- 
branes, and  lymphatic  glands — for  cancer. 

In  1893  I  had  collected  statistics  of  forty  cases.  These  sufficed  for 
a  description  of  the  principal  forms  of  the  infection,  its  localisations, 
and  its  anatomical  and  pathological  characters.* 

Pursuing  my  researches  on  the  patients  brought  to  the  outer  clinique, 
and  assisted  by  students  who  followed  them  up  in  the  surgical  hospital, 
I  was  able  to  collect  165  new  cases  in  which  diagnosis  was  verified  by 
post-mortem  examination. 

In  the  dog  the  localisations  of  tuberculosis  are  as  varied  as  in  other 
species.  Sometimes  lesions  are  rare,  limited  to  a  few  organs,  or  even 
to  only  one  ;  much  more  frequently  they  are  found  in  the  majority  of 
the  viscera  and  lymphatic  glands,  and  with  a  fair  degree  of  frequency 
in  the  pleura  and  peritoneum.  In  the  205  cases  at  present  collected 
the  thoracic  and  abdominal  viscera  have  been  invaded  in  140  cases,  in 

*   Cadiot,  '  La  Tuberculose  du  Chien,'  Paris,  1893. 


TUBERCULOSIS    IN    THE    DOG. 


237 


53   the  lesions  have  been  confined  to  the  thoracic,  and  in    12   to  the 
abdominal  organs.     The  figures  are  as  follows  : 


Thoracic  Cavity. 

Tuberculosis  of  the  lung 

158 

cases 

>) 

bronchial  and  mediastinal  glands 

.     114 

35 

pleura    ..... 

.       83 

53 

pericardium   .... 

•       39 

>J 

myocardium  .... 

.       16 

JJ 

endocardium  .... 
A  hdominal  Cavity. 

3 

Tuberculosis 

of  the 

liver 

iiq 

cases 

j> 

jj 

kidney    ..... 

76 

'» 

j> 

)j 

mesenteric  glands  . 

62 

>5 

peritoneum     .... 
intestine          .... 

57 

18 

J> 

The  pleura,  pericardium,  and  peritoneum  are  frequently  the  seat  of 
serous  or  sero-fibrinous,  and  sometimes  purulent  or  haemorrhagic 
exudation.  I  have  seen  pleurisy  in  ninety  cases,  pericarditis  in  twenty- 
eight,  and  ascites  in  forty-nine. 

I  have  laid  stress  on  the  frequency  of  pleurisy  as  a  common  accident 
in  tuberculosis  ;  specific  inflammation  of  the  pleura,  with  serous  or 
purulent  exudate,  has  been  found  in  almost  one  half  of  the  subjects 
examined.  And  just  as  pleural  inflammation  is  common  in  dogs 
affected  with  tuberculosis,  it  is  exceptional  in  non-tuberculous  patients ; 
so  far  as  canine  pathology  is  concerned,  this  is  with  me  a  fixed  idea. 
Examining  my  last  fifty  cases  of  canine  pleurisy  from  this  point  of  view 
— I  am  now  only  speaking  of  cases  in  which  diagnosis  was  checked  by 
post-mortem  and  bacteriological  examination — I  found  tuberculosis  to 
be  the  cause  in  forty-one  instances,  that  is  to  say  in  82  per  cent,  of 
cases — a  proportion  approximately  the  same  as  that  arrived  at  for  man 
by  the  most  recent  researches. 

Exudative  pericarditis  also  is  usually  symptomatic  of  tuberculous 
infection,  though,  like  pleurisy,  it  may  be  seen  alone,  without  any  other 
specific  localisation. 


Certain  manifestations  of  tuberculosis  in  the  dog  are  atypical,  and 
sometimes  very  different  from  those  usually  seen,  the  lesions  of  the  liver 
and  epiploon  being  the  most  remarkable.  You  know  that  the  tuber- 
culous liver  generally  shows  a  large  number  of  little  whitish,  greyish,  or 


238  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

yellowish  nodules,  of  rather  firm,  uniform  consistence,  the  majority 
varying  in  size  between  a  hemp-seed  and  large  pea.  Many  of  those  in 
the  superficial  layers  of  the  organ  are  hemispherical  or  conical — their 
base  resting  on  Glisson's  capsule — with  finely  dentated  circumference 
(Fig.  18).  The  largest  have  a  whitish  periphery  and  slightly  depressed 
yellowish  centre  ;  a  few  of  smaller  size  sometimes  present  a  glistening 


Fig.  18. — Tuberculosis  of  the  liver. 

nacreous  appearance,  and  a  central  opaque,  caseous  point.  In  this 
form  the  lesions  are  somewhat  similar  to  those  seen  in  hepatic  tuber- 
culosis of  fowls,  and  have  often  been  mistaken  for  cancer.  Straus 
himself,  on  examining  the  liver  I  sent  him,  at  first  thought  I  must  have 
been  mistaken,  so  similar  were  the  lesions  to  cancerous  nodules.  In 
some  subjects,  instead  of  presenting  this  appearance,  the  liver  is 
deformed  by  large  yellowish-white  tuberculous  areas  of  uniform  sar- 
comatous consistence,  or  softened  and  excavated  at  their  centre  by  a 
more  or  less  spacious  cavity  filled  with  greyish  or  lactescent  fluid.  In 
this  liver,  which  was  removed  from  a  dog  killed  a  few  months  ago,  you 
see  this  atypical  form  of  tuberculosis  ;  the  lesions  appear  as  large 
yellowish-white  cystic  tumours,  fluctuating  throughout  the  greater 
portion  of  their  area,  covered  with  branching  vessels,  but  firmer 
towards  their  margins,  which  are  sharply  defined  (Fig.  19). 

The  mesentery  and  epiploon,  which  are  sometimes  thickened  and 
indurated,  are  generally  dotted  over  with  granules  and  isolated  or  con- 
fluent tubercles.  They  may  also  be  the  seat  of  hyperplastic  changes 
producing  atypical  lesions  described  as  sarcomatous.     The  epiploon 


TUBERCULOSIS    IN    THE    DOG. 


239 


especially  ma}'  become  so  large  as  to  be  almost  unrecognisable.     In  a 
dog  dead  of  generalised  chronic  tuberculosis  I  found  the  epiploon  had 


Fig.  19. — Tuberculosis  of  the  liver  (atypical  form). 


Fig.  20. — Tuberculosis  of  the  epiploon.     R,  spleen. 

assumed  the  form  of  a  flattened   rectangular,  slightly  incurved  mass,, 
with  irregular,  rounded  projections,   marked   by  vascular  striae  ;    the 


;240  CLINICAL    VETERINARY    iMEDICINE    AND    SURGERY. 

spleen,  which  rested  on  it,  was  absolutely  unaffected  (Fig.  20).  Its 
tissue  was  very  dense,  of  fibrous  consistence,  and  creaked  under  the 
knife  ;  transverse  sections  were  nearly  an  inch  in  thickness,  appeared 
whitish  in  colour,  and  were  dotted  over  with  caseous  or  cretaceous 
granulations,  which  could  be  shelled  out  without  much  difficult}^ 

In  only  two  cases  have  I  seen  "tuberculous  septicaemia,"  and  in 
both  the  dogs  were  less  than  a  year  old.  In  one  the  blood  had  become 
infected  from  a  pulmonary  cavernous  space ;  in  the  other,  from  an 
abscess  in  a  lymphatic  gland. 

The  latter  case  dates  from  September,  1893.  It  was  brought  here 
on  account  of  steadily  progressive  emaciation  and  enlargement  of  the 
abdomen.  On  noting  the  ascites,  and  learning  that  the  dog  belonged 
to  a  wine-shop  keeper,  I  suspected  tuberculosis.  The  animal  was  left  at 
the  School  to  be  tested  with  tuberculin.  It  died  next  day.  The  lesions 
found  on  post-mortem  examination  were  of  quite  a  different  character  from 
those  usually  seen  in  tuberculous  patients.  I  preserved  the  liver  and 
spleen.  These  organs  were  free  of  tubercles  and  granulations,  and  only 
attracted  attention  by  their  enormous  size  and  the  appearance  of  their 
tissue;  the  liver,  which  weighed  nearly  2  lbs.,  was  yellowish,  and  had 
undergone  fatty  degeneration  ;  the  spleen  was  blackish,  its  tissue  very 
friable,  and  except  for  the  difference  in  colour  resembled  a  lymphade- 
nomatous  spleen.  Both  organs  contained  enormous  quantities  of 
bacilli,  which  on  microscopical  examination  appeared  as  broad  tracts, 
and  were  as  numerous  as  in  cover-glass  preparations  from  a  culture. 

The  diagnosis  of  tuberculosis  in  the  dog  may  be  founded  on  clinical 
signs  and  the  use  of  tuberculin,  and  is  confirmed  by  discovery  of  bacilli 
in  the  nasal  discharge  or  in  the  pus,  and  by  inoculation. 

Although  the  usual  symptoms  are  by  no  means  characteristic  they 
can  scarcely  be  mistaken  for  those  of  visceral  cancer  (sarcoma  or  car- 
cinoma) ;  and  the  fact  of  their  existence  implies  a  great  probability  that 
the  disease  is  tuberculous,  for  in  the  dog — contrary  to  the  still  widely 
held  opinion — tuberculosis  is  much  commoner  than  generalised  cancer. 
In  post-mortem  examinations  carried  out  during  the  last  five  years  I 
have  several  times  had  series  of  ten,  fifteen,  and  even  twenty  cases  of 
tuberculosis  for  each  case  of  generalised  cancer. 

As  in  other  species  of  animals,  tuberculin  is  a  good  test  for  tubercu- 
losis. At  the  commencement  of  my  experiments  I  injected  many 
suspected  dogs  without  producing  any  apparent  reaction.  But  if 
tuberculin  appeared  so  unreliable,  it  was  because  my  method  was 
faulty  ;  I  injected  the  dogs  in  the  evening  about  9  p.m.,  and  only  took 
the  temperature  every  two  hours  after  6  a.m.  next  morning :  in  most 


TUBERCULOSIS    IN    THE    DOG.  24I 

cases  the  characteristic  temperature  reaction  had  then  passed.  From 
the  temperature  charts  of  forty  animals  injected  with  tubercuhn,  I  have 
found  that  the  maximum  reaction  occurs  between  the  fourth  and  eighth 
hours.  In  general  it  is  quite  distinctive.  With  doses  of  5  to  10  centi- 
grammes of  tuberculin  the  temperature  rises  from  1°  to  3°  C.  Tuber- 
culous cases,  however,  do  occur,  especially  among  animals  which  are 
very  feeble  or  affected  with  generalised  lesions,  in  which  the  reaction  is 
trifling  or  nil.  Quite  recently  I  saw  a  Danish  boarhound,  still  in  fairly 
good  health,  but  proved  by  subsequent  post-mortem  examination  to  be 
distinctly  tuberculous,  which  did  not  react  in  the  smallest  degree 
to  two  injections  of  tuberculin,  although  the  initial  temperature  was  on 
the  first  occasion  38°  C.  (ioo"4°  F.),  and  on  the  second  38*3°  C. 
(100-9°  F.). 

How  does  the  dog  contract  tuberculosis  ?  One  fact  at  least 
appears  certain,  viz.  that  canine  tuberculosis  is  of  human  origin.  The 
numerous  inquiries  I  have  made  leave  no  doubt  on  this  point.  Either 
the  animal  belonged  to  a  phthisical  patient  or  associated  with  a  tuber- 
culous person  with  whom  it  passed  a  portion  of  the  day,  or  it  accom- 
panied its  master  daily  to  the  wine-shop  or  eating-house — places  where 
in  very  many  instances  the  floor  is  soiled  with  sputum  containing 
bacilli. 

In  the  dog,  also,  there  are  two  principal  avenues  of  infection,  the 
digestive  and  the  respiratory  mucous  membranes.  At  first  sight,  having 
regard  to  the  extreme  frequency  of  pulmonary  lesions  and  the  diffi- 
culty of  transmitting  tuberculosis  to  the  dog  by  ingestion  of  virulent 
material,  it  seems,  as  Straus  has  remarked,  that  infection  occurs  often- 
est  by  the  respiratory  passages,  in  consequence  of  the  dog  inhaling 
infected  dust.  This  is  also  the  opinion  I  emitted  in  my  work  in  1893, 
but  despite  the  negative  results  of  experiments  in  which  dogs  were 
caused  to  ingest  tuberculous  material,  despite  the  common  absence  of 
lesions  indicating  the  passage  of  bacilli  from  the  intestinal  mucous 
membrane,  and  from  the  lymphatic  glands  originating  there  ;  finally, 
despite  the  predominance  of  pulmonary  lesions,  infection  is  caused  at 
least  as  often  by  the  ingestion  of  virulent  material  as  by  the  inhalation 
of  infective  dust. 

We  know  that  many  dogs  have  a  propensity  to  lick  up  human  sputa  ; 
some  will  even  go  to  the  spittoons.  In  1893  I  made  the  post-mortem 
examination  of  a  young  dog  which  became  tuberculous  under  the  follow- 
ing circumstances  : — Its  master,  M.  V — ,  living  in  the  Boulevard  de 
Picpus,  in  Paris,  became  affected  with  pulmonar}-  tuberculosis.  The 
doctor  who  treated  him  recommended  the  use  of  a  special  recipient  for 

Q 


242  CLINICAL   VETERINARY    MEDICINE    AND    SURGERY. 

sputum.  In  order  to  guard  the  dog  against  distemper  Mme.  V — , 
following  the  advice  of  some  gossip,  gave  the  animal  from  time  to  time 
the  contents  of  the  spittoon.  This  went  on  for  several  months.  The 
dog  ended  by  becoming  tuberculous.  Large  lesions  in  the  mesenteric 
glands  and  liver  showed  that  infection  had  occurred  through  the 
intestine. 

Without  reference,  however,  to  the  source  and  channel  of  infection, 
the  dog  may  become  dangerous  to  man  as  soon  as  affected  with  lesions 
from  which  contagious  material  is  externally  discharged.  A  tubercu- 
lous dog  which  lives  in  or  enters  rooms  inhabited  by  its  master  may 
there  distribute  such  discharge.  If  it  plays  with,  is  petted,  or  looked 
after  by  children,  this  discharge  may  come  in  contact  with  their  clothes, 
or  even  with  their  faces.  Pet  dogs  may  even  infect  the  sleeping  apart- 
ments or  beds  of  their  owners.  In  1894  I  was  several  times  consulted 
by  Mme.  C — ,  living  in  the  Rue  Favart,  at  Paris,  concerning  a  little 
terrier  which  for  a  long  time  had  appeared  thin,  and  at  intervals  had 
shown  cough  and  nasal  discharge.  The  dog  was  very  closely  watched,  and 
without  doubt  had  contracted  tuberculosis  in  one  of  the  watering-places 
in  the  south  of  France  where  Mme.  C —  annually  resorted.  I  informed 
her  that  the  dog  was  probably  tuberculous,  and  suggested  the  necessary 
precautions  to  take,  but  only  after  some  time  would  she  consent  to 
send  it  away.  Though  ill  for  a  whole  year  the  animal  had  passed  most 
of  its  time  in  Mme.  C — 's  living  room,  and  all  its  nights  in  her  sleeping 
apartment.  The  post-mortem  examination  of  this  dog  showed,  in  addi- 
tion to  other  lesions,  cavernous  spaces  in  both  pulmonary  lobes  and 
a  tuberculous  ulcer  in  the  larynx. 

My  case-books  contain  a  number  of  instances  of  this  kind.  I  will 
only  relate  the  most  recent.  On  the  13th  October  last  a  dog,  which 
the  owner,  a  working  man,  thought  pure-bred  and  of  great  value,  was 
killed  when  in  the  last  stage  of  emaciation.  Its  existence  had  been 
passed  in  two  rooms,  inhabited  by  this  man,  his  wife,  a  three-year-old 
child,  and  the  dog.  The  dog  had  been  ill  for  five  months,  had  had 
frequent  attacks  of  coughing,  discharge  from  the  nose,  and  vomiting. 
It  had  not  left  the  house  except  on  the  day  when  it  was  brought  to 
Alfort.  On  post-mortem  examination  we  found  generalised  tuberculous 
lesions ;  both  lungs  were  full  of  tubercles,  and  in  part  destroyed  by 
cavernous  spaces. 

You  have  noted  that  many  tuberculous  dogs  show  no  discharge,  or 
only  a  trifling  running  from  the  nose,  and  in  the  majority  of  those 
which   do  discharge  the  material  is  only  seen  at  certain  times.     But 


TUBERCULOSIS    IN    THE    DOG.  245 

other  secretions  maj'  disseminate  contagion.  Thus  in  animals  with 
pulmonary  tuberculosis  the  fasces  are  more  or  less  charged  with  bacilli 
derived  from  the  muco-pus  ejected  from  the  bronchi  into  the  pharynx, 
and  afterwards  swallowed. 

Several  cases  have  been  recorded  showing  that  dogs  with  lesions  of 
the  kidneys  or  of  the  prostate  also  spread  the  virus  by  means  of  the 
urine.  I  published  the  first  in  1897.  It  was  that  of  a  dog  with 
generalised  tuberculosis.  The  kidneys  were  crammed  with  tubercles 
which  had  almost  entirely  destroyed  the  cortical  layer.  The  prostate 
was  ten  times  its  normal  size,  and  its  right  lobe  contained  a  cavernous 
space.  On  compressing  the  gland,  after  having  incised  the  urethra, 
greyish  pus,  rich  in  bacilli,  was  seen  to  escape  from  its  excretory  ducts. 
Large  numbers  of  bacilli  were  also  present  in  the  urine  contained  in 
the  bladder.  These  renal  and  prostatic  lesions  were  relatively  old. 
For  several  months,  therefore,  the  animal  had  been  spreading  tuber- 
culous virus  by  means  of  the  urine. 

In  one  of  our  next  lectures  I  shall  speak  of  external  forms  of 
tuberculosis  in  the  dog  and  cat,  and  shall  show  that  these  animals  may 
become  the  subjects  of  tuberculous  ulcers  of  the  skin,  hitherto  mistaken 
for  harmless  lesions. 


XXXIIL— TUBERCULOSIS    IN    THE    CAT. 

Very  much  less  has  been  written  on  the  history  of  tuberculosis  in 
the  cat  than  in  the  dog.  The  cases  hitherto  reported  are  very  scanty. 
I  have  only  found  thirty-one  in  special  publications,  either  French  or 
foreign,  and  the  majority  only  mention  lesions  seen  on  post-mortem 
examination.  Among  these  are  comprised  the  twenty-two  cases  seen 
by  Jensen  while  searching  for  tuberculosis  among  cats  killed  at  the 
Veterinary  School  of  Copenhagen  during  the  thirteen  months  from 
November,  1889,  to  January,  1891,  and  the  three  cases  previously 
•collected  by  Bang,  and  published  in  Jensen's  article.  To  these  I  can 
add  ten  other  cases  seen  in  the  consulting  clinique ;  in  most  cases  the 
animals  were  given  up  by  their  owners,  and  either  died  of  tuberculosis 
■or  were  destroyed.  This  makes,  therefore,  a  grand  total  of  forty-one 
observations. 

I  have  analysed  these  cases  in  order  to  show  the  relative  frequence 
of  the  local  lesions.  The  results  are  as  follows  : — Changes  in  the  lungs, 
29  cases  ;  in  the  bronchial  and  mediastinal  glands,  10 ;  in  the  pleura, 
3 ;  in  the  trachea  and  nasal  cavities,  i ;  in  the  pericardium  and  heart, 

1  ;  in  the  intestine,  4 ;  in  the  mesenteric  lymphatic  glands,  22  ;  in  the 
liver,  5  ;  spleen,  4  ;  peritoneum  (mesentery  and  epiploon),  5  ;  kidneys, 
8  ;  testicles,  i  ;  uterus,  i  ;  submaxillary  and  cervical  lymphatic  glands? 

2  ;  muscles,  i  ;  articulations,  2.  Pleurisy  was  seen  in  4  cases,  and 
pericarditis  in  2.     Four  animals  showed  tuberculous  wounds. 

On  comparing  these  figures  with  those  referring  to  similar  lesions 
in  the  dog  analogies  are  seen,  but  also  notable  differences.  In  both 
species  the  lung  is  the  most  frequently  affected  organ.  In  the  cat 
lesions  of  the  intestine,  mesenteric  lymphatic  glands,  and  spleen  are 
■commoner  than  in  the  dog,  while  lesions  of  the  liver  and  serous 
membranes,  ascites,  pleurisy,  and  pericarditis  are  rarer.  Nevertheless 
it  must  be  borne  in  mind  that  in  a  considerable  number  of  cases  the 
animals  were  killed,  and    the  post-iiwriciii    examination    only  revealed 


TUBERCULOSIS    IN    THE    CAT, 


245 


recent  lesions.  Could  a  large  number  of  cases  of  advanced  tuberculosis 
in  both  species  be  compared,  the  differences  would  probably  be  less 
marked. 

The  macroscopic  and  microscopic  characters  of  tuberculous  lesions 


Fig.  21. — Tuberculous  pneumonia.     Section  through  the  right  lung 
showing  cavernous  spaces. 


Fig.  22. — Tuberculosis  of  the  tracheo-bronchial  and  mediastinal  glands. 

in  the  cat  are  very  similar  to  those  in  the  dog.  The  lungs  show  recent 
greyish  granulations  of  homogeneous  consistence,  tubercles  with  softened 
purulent  centres,  yellowish-grey  areas  formed  of  agglomerations  of 
tubercle,  and  more  rarely  diffuse  chronic  pneumonia  with  formation  of 


246  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

cavernous  spaces  (Fig.  21).  In  some  cases  only  one  or  two  large  lesions 
may  exist ;  in  others  both  lobes  are  crammed  with  granules.  Secondary 
lesions  may  also  be  seen,  such  as  those  of  bronchitis  and  peribronchitis, 
broncho-pneumonia,  bronchiectasis,  emphysema,  or  pulmonary  oedema. 

The  tracheo-bronchial  glands,  which  are  almost  always  affected  in 
cases  of  pulmonary  tuberculosis  of  any  age,  usually  show  moderate 
enlargement,  appearing  as  a  collection  of  little  hardened  masses  the 
size  of  a  pea,  haricot  bean,  or  almond.  As  in  the  dog,  they  may, 
however,  become  of  large  size,  forming  an  ovoid  or  irregular  mass 
surrounding  the  terminal  portion  of  the  trachea,  the  origin  of  the 
bronchi,  the  large  vessels  at  the  base  of  the  heart,  and  the  nerves 
traversing  this  region  (Fig.  22)  ;  on  section  their  tissue  appears  greyish 
or  marbled  with  black  lines,  and  dotted  over  with  whitish,  hard  or 
softened  caseous  tubercles.  They  may  .undergo  cystic  transformation  : 
the  centre  is  then  occupied  by  a  cavity  filled  with  greyish  or  slightly 
lactescent  liquid. 

In  the  majority  of  cases  of  pulmonary  tuberculosis  the  visceral 
layer  of  the  pleura  is  thickened,  injected,  and  covered  with  false 
membranes  opposite  the  seat  of  the  pulmonary  disease  centres.  Some- 
times the  costal  and  diaphragmatic  portions  of  the  pleura  are  covered 
with  granulations ;  sometimes  the  mediastinum  and  its  lymphatic 
glands  show  change.  Finally,  one  or  both  of  the  pleural  sacs  and  the 
pericardium  may  contain  a  varying  quantity  of  serous  or  purulent 
liquid. 

Intestinal  tuberculosis  is  characterised  by  ulcerations  of  varying 
extent,  depth,  and  number,  which  sometimes  perforate  the  bowel.  The 
mesenteric  lymphatic  glands  are  very  commonly  diseased.  Opposite 
the  caecum  they  are  usually  confluent,  forming  yellowish  bosselated 
masses,  with  caseous  or  purulent  centres.  The  liver  often  contains  a 
very  large  number  of  fine  granules,  isolated  or  massed  together.  Until 
now  the  voluminous  cystic  new  growths  occasionally  seen  in  the  dog 
have  not  been  described  in  the  cat.  The  spleen  is  simply  enlarged  or 
nodular  on  the  surface ;  sections  through  its  tissue  show  granulations 
and  tubercles,  the  largest  scarcely  exceeding  a  pea  in  size.  In  tuber- 
culosis of  the  kidney  the  external  surface  of  the  organ  and  the  surface 
of  sections  sometimes  show  fine  granulations,  sometimes  tubercles,  or 
even  greyish-white  tuberculous  areas,  with  cystic  or  purulent  centres. 
Lesions  of  chronic  nephritis  are  not  uncommon.  Bang  claims  to  have 
seen  a  case  of  primary  tuberculosis  of  the  right  kidney.  As  tuberculosis 
of  the  organs  of  generation  is  very  rare  I  shall  merely  mention  the  case 
of  primary  tuberculosis  of  the  uterus  seen  by  Jensen  in  a  female  cat, 
and  recorded  by  him  as  an  example  of  infection  per  coitiim — tuberculosis 


TUBERCULOSIS    IN    THE    CAT.  247 

of  the  testicle  having  been  met  with  in  the  cat.  Tuberculosis  of  the 
peritoneum  is  even  less  common  than  that  of  the  pleura.  The  parietal 
layer  is  usually  free ;  the  lesions  are  limited  to  the  epiploon  and 
mesentery,  which  appear  thickened  and  dotted  over  with  fine  granules. 
The  peritoneal  sac  may  contain  more  or  less  abundant,  clear  or 
purulent  serosity,  either  poor  or  moderately  rich  in  bacilli. 

External  tuberculous  lesions,  with  and  without  ulceration,  have 
several  times  been  noted.  I  described  two  cases  in  a  preceding 
lecture. 

The  paths  of  infection  are  multiple,  but  the  two  principal  are  the 
digestive  and  respiratory  mucous  membranes. 

In  most  cases  the  bacilli  enter  the  organism  through  the  intestinal 
mucous  membrane.  In  this  way  cats  which  ingest  offal,  milk,  or  other 
material  derived  from  tuberculous  animals,  food  infected  by  a  tuber- 
culous patient,  or  purulent  sputum,  may  become  infected.  Nevertheless 
cats  may  also  contract  tuberculosis  by  living  in  rooms  in  which  the 
atmosphere  is  charged  with  tuberculous  dust.  We  know  that  in  all 
species  infection  occurs  readily  through  the  respiratory  mucous  mem- 
brane. Passage  of  bacilli  through  other  mucous  membranes,  and 
through  the  skin,  is  exceptional. 

Contrary  to  the  most  widely  held  opinion,  and  to  what  one  would  be 
led  to  believe  from  the  conditions  of  life  and  habits  of  the  cat,  tuber- 
culosis in  this  animal  is  most  frequently  of  human  origin.  In  more 
than  three  fourths  of  the  cases  where  the  probable  method  of  contagion 
could  be  traced,  infection  from  man  appeared  indicated.  The  animals 
belonged  to  tuberculous  subjects  or  lived  in  intimacy  with  them.  In 
this  connection  the  following  interesting  observation  was  made  to  me 
by  my  colleague,  M.  Darras,  a  veterinary  surgeon  in  Paris  : 

"  Mme.  X — ,  concierge,  had  for  four  years  owned  a  family  of  six 
cats,  all  of  them  superb,  vigorous  animals,  in  very  good  health. 
Towards  the  end  of  1894  these  animals  began  to  grow  thin  and  cough. 
The  oldest  one  soon  died.  The  post-morteui  examination,  made  at 
Alfort,  showed  that  death  had  resulted  from  tuberculosis.  Both  the 
thoracic  and  abdominal  organs  were  affected.  Shortly  afterwards  a 
female  kitten,  which  had  become  very  thin,  showed  multiple  disease 
of  lymphatic  glands ;  the  glands  in  the  neck  were  especially  large.  It 
died  at  the  end  of  a  month.  Post-vwrtem  examination  showed  no 
intestinal  or  pulmonary  lesion,  but  the  mesenteric  glands  were  enlarged, 
and  the  spleen  (which  \vas  of  great  size)  displayed  very  numerous 
granulations.  No  bacteriological  examination  was  made.  At  the  end 
of  six  months   two   other   cats  which  had  fallen  away  in  condition. 


24©  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

although  continuing  to  feed  well,  began  to  cough  and  to  rapidly  pine 
away.  On  my  advice  the  worst  case  was  killed.  It  showed  abdominal 
tuberculosis,  and  bacteriological  examination  revealed  the  presence  of 
bacilli  in  the  lesions.  The  other,  which  was  much  troubled  with  cough, 
died  two  months  later.  On  autopsy  tuberculous  lesions  were  found  in 
the  abdominal  organs  and  lung.  Finally  one  of  the  survivors  showed 
symptoms  which  caused  me  to  suspect  it  of  tuberculosis. 

"  All  the  cats  had  enjoyed  good  health  before  the  arrival  in  the 
house  of  a  family  containing  several  consumptives.  The  symptoms 
they  showed,  and  the  diagnosis  given  by  several  doctors,  left  no  doubt 
as  to  the  nature  of  the  disease  from  which  they  were  suffering.  The 
members  of  this  family  (who  were  very  fond  of  animals)  used  to  allow 
Mme.  X — 's  cats  into  their  rooms,  and  were  in  the  habit  of  giving  them 
the  remains  of  their  meals.  In  this  way  the  animals  probably  became 
infected." 

Contagion  by  tuberculous  animals  and  their  products  appears  less 
common  than  the  preceding.  In  rural  districts,  where  tuberculous 
cows  are  common,  cats  which  live  or  pass  the  greater  part  of  their 
time  in  the  byre,  and  which  consume  milk  from  these  animals,  are 
exposed  to  infection.  But  in  Paris  (as  in  all  large  towns  and  their 
neighbourhoods)  the  cat  is  very  rarely  infected  by  animal  products. 
Since  1892  I  have  bred  thirty  or  more  cats,  feeding  them  on 
bread,  a  little  chopped  horse-flesh,  but  principally  on  raw  milk  from 
the  Alfort  cowsheds,  the  neighbouring  localities,  and  the  various  parts 
of  Paris.  In  most  cases  the  feeding  on  raw  milk  was  continued  for 
five  to  six  months,  and  in  some  for  more  than  a  year.  None  became 
tuberculous,  and  none  showed  any  tuberculous  lesion  on  post-mortem 
examination. 


XXXIV.— HyEMOGLOBINURIA    (AZOTURIA)    IN    THE 

HORSE. 

The  day  before  yesterday  we  made  a  post-inovton  examination  of 
an  eight-year-old  stallion  which  had  died  after  an  illness  of  three  days' 
duration.  It  was  in  good,  even  plethoric  condition,  and  had  been 
attacked  while  at  work  and  apparently  in  full  health,  showing  in  a  few 
minutes  paralysis  of  the  hind  quarters  and  a  number  of  extremel}- 
grave  symptoms.  The  animal  had  for  some  years  been  regularly 
working  for  a  firm  of  carters  in  Paris.  On  the  ist  and  2nd  January  it 
had  been  left  in  the  stable,  which  was  badly  ventilated.  The  morning 
of  the  3rd  January  was  cold,  and  after  a  quarter  of  an  hour's  work  at  a 
quiet  trot  the  horse  slackened  his  pace,  sweated  profusely  over  the  hind 
quarters,  showed  weakness  of  the  hind  limbs,  and  while  the  driver  (who 
thought  the  animal  was  suffering  from  colic)  was  wondering  what  he 
ought  to  do,  the  horse  fell  down  in  the  shafts.  It  was  unharnessed  and 
helped  up.  It  took  a  few  steps,  dragging  the  left  hind  limb  along  the 
ground,  and  again  fell.  It  was  then  put  into  an  ambulance  to  be 
taken  back  to  the  stable.  A  veterinary  surgeon  who  was  called  in  bled 
it,  applied  stimulant  applications,  and  afterwards  sent  it  to  the  School. 

On  its  arrival  we  in  vain  attempted  to  place  it  on  its  legs.  It  had 
to  be  let  down  on  the  straw  of  the  hospital  theatre,  where  it  lay 
struggling  violently.  The  mucous  membranes  were  injected,  the 
circulation  and  respiration  very  rapid ;  the  pulse  80  ;  respirations  30 ; 
rectal  temperature  39°  C.  (102*2°  P.).  The  muscles  of  the  croup  and 
left  quarter  were  swollen  and  hard,  and  the  subcutaneous  connective 
tissue  covering  them  appeared  infiltrated.  On  passing  the  catheter 
about  a  quart  of  brownish  urine  was  drawn  off. 

The  body  was  smartly  rubbed,  and  ten  centigrammes  of  eserine 
sulphate  hypodermically  injected,  producing  several  evacuations.  The 
animal  was  then  covered  up.  It  received  milk  and  mashes,  to  which 
were  added  three  and  a  half  ounces  of  bicarbonate  of  soda.  During  the 
evening,  in  order  to  quiet  it,  I  further  prescribed  a  hypodermic  injection 
of  morphine  and  chloral  enemata. 


250  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

Next  day,  and  the  day  following,  the  animal  was  several  times 
lifted,  but  was  unable  to  remain  standing ;  it  was  therefore  placed 
on  a  deep  bed  of  straw  and  turned  over  morning  and  evening ; 
food  and  drink  were  frequently  offered ;  the  urine  was  drawn  off  by 
catheter,  and  the  rectum  from  time  to  time  emptied.  In  spite  of  all 
our  care  the  symptoms  became  aggravated.  On  the  evening  of  the 
third  day  great  excitement  set  in ;  the  mucous  membranes  were 
cyanosed,  the  body  covered  with  sweat,  the  respirations  ver}-  rapid 
and  embarrassed  ;  the  pulse  rapid,  small,  and  thready,  and  the  tempe- 
rature rose  to  40*3°  C.  (104-5°  F.).     Death  occurred  during  the  night. 

On  post-mortem  examination  you  were  struck  by  the  change  in  the 
muscular  tissue.  The  muscles  of  the  croup,  quarter,  buttock,  and 
sublumbar  region  were  swollen,  discoloured,  yellowish,  infiltrated,  and 
at  points  ecchymosed.  The  longissimus  dorsi,  pectoral  muscles,  and 
the  extensors  of  the  forearm  showed  similar  though  less  marked 
changes.  Both  kidneys  were  slightly  enlarged.  On  section  the 
cortical  layer  appeared  hypersemic,  infiltrated,  and  haemorrhagic  ;  the 
medullary  layer,  where  in  contact  with  the  cortex,  was  injected,  but 
towards  the  pelvis  was  of  a  yellowish  tint.  The  bladder  contained  a 
little  blackish  urine.  The  nervous  centres  showed  no  important 
lesions,  though  the  -spinal  cord  was  slightly  congested,  especially 
opposite  the  commencement  of  the  cauda  equina.  The  intestine  was 
hyperaemic  at  places;  the  liver  large  and  the  colour  of  a  dead  leaf;  the 
spleen  swollen,  deformed  by  several  rounded  enlargements,  below 
which  its  tissue  was  softened  and  haemorrhagic  ;  the  left  lung  hypo- 
statically  congested  and  infiltrated ;  the  myocardium  discoloured  and 
yellowish  ;  the  endocardium  marked  with  a  few  ecchymoses  ;  the  blood 
uncoagulated,  blackish,  and  slightly  gummy.  But  these  latter  are 
accessory  lesions,  and,  moreover,  inconstant. 

Last  week  you  saw  an  eight-year-old  gelding  belonging  to  a  market 
gardener  of  Maisons-Alfort  recover  from  the  same  disease.  Like  the 
preceding  case,  this  horse  had  been  kept  in  the  stable  for  two  days,  and 
after  breakfast  on  the  27th  December  was  harnessed  to  draw  some 
vegetables  to  Paris.  The  weather  was  cold,  the  thermometer  marking 
6  degrees  below  zero  C.  (22°  F.).  The  horse  walked  from  Maisons- 
Alfort  to  Alfort,  about  one  and  a  quarter  miles.  In  passing  over 
Charenton  bridge  it  relaxed  its  speed,  and  suddenly  went  lame  on  the 
off  hind  leg.  A  little  further  on  it  stopped,  apparently  suffering  from 
slight  colic.  The  driver  let  it  rest  for  a  few  minutes,  rubbed  the  abdo- 
men with  a  wisp  of  straw,  and  then  as  the  pain  diminished  resumed  his 
journey. 


H.'EMOGLOBINURIA    (aZOTURIA)    IN    THE    HORSE.  25  I 

Two  hundred  yards  further  on  the  horse  fell  down.  Being  imme- 
diately taken  out  of  harness  it  was  able  to  rise.  After  a  few  minutes' 
rest  it  was  brought  to  the  School,  where  it  arrived  bathed  in  sweat, 
with  an  anxious  appearance  about  the  face,  and  the  off  hind  limb  par- 
tially paralysed.  It  almost  immediately  passed  a  little  thick,  viscous, 
coffee-coloured  urine.  Although  the  body  and  hind  quarters  were 
smartly  rubbed,  paralysis  of  the  hind  limbs  quickly  increased.  The 
animal  lay  down,  its  respiration  became  rapid  and  tremulous,  the  pulse 
accelerated  and  strong  ;  temperature  39*1"  C.  (i02'3"  F.).  Eight  centi- 
grammes of  eserine  sulphate  were  injected  subcutaneously  in  the  neck  ; 
the  animal  was  warmly  covered  up,  and  given  a  lukewarm  draught  con- 
taining bicarbonate  of  soda.  During  the  evening  it  took  some  mash, 
milk,  and  a  little  hay.  It  also  received  nearly  gh  ounces  of  bicarbonate 
of  soda. 

Next  morning  we  found  it  in  a  fairly  satisfactory  state.  There  was 
little  excitement,  and  the  face  appeared  more  natural.  The  respira- 
tions were  from  16  to  20,  the  pulse  60  to  70  per  minute,  temperature 
38'9°  C.  (102°  F.).  It  was  turned  over  twice  during  the  day.  As  on 
the  previous  day,  it  took  a  little  hay,  some  milk,  and  mashes,  to  which 
considerable  quantities  of  bicarbonate  of  soda  had  been  added.  The 
rectum  was  cleared  out,  and  the  urine  drawn  off. 

This  treatment  was  continued  for  the  next  two  days.  The  general 
condition  seemed  to  improve,  but  the  animal  was  still  unable  to 
stand. 

On  visiting  it  on  the  morning  of  the  fourth  day  it  was  found  able 
to  stand,  and  was  therefore  kept  up  for  a  few  minutes  by  passing 
strong  bars  of  wood  under  the  chest,  while  the  body  and  hind  limbs 
were  rubbed.  With  assistance  it  was  moved  into  a  box  and  placed  in 
slings. 

Improvement  followed  rapidly,  and  in  a  few  days  the  horse  was  able 
to  leave  hospital  completely  recovered.  From  the  symptoms  and  lesions 
just  described  you  will  recognise  a  disease  which  was  at  first  known 
under  the  titles  of  enzootic  paraplegia,  congestion  of  the  cord,  then  by 
the  names  of  hasmoglobinaemia,  or  hasmoglobinuria  afrigore,  the  latter 
distinctions  being  derived  from  human  medicine,  where  they  were 
applied  to  a  disease  which  had  some  characters  in  common  with  haemo- 
globinuria  of  the  horse.  Kiissner  called  the  disease  paroxysmal  haemo- 
globinuria,  and  Mesnet  haemoglobinuria  a  frigore. 

To-day  I  wish  to  go  beyond  a  mere  sketch  of  the  clinical  appear- 
ances, and  to  speak  more  fully  of  this  disease,  which  has  recently  been 
the  subject  of  interesting  researches. 

For  a  long  time  the  conditions  in  which  haemoglobinuria  usually 


252  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

appears  have  been  recognised.  One  cause — the  action  of  which  is 
certain — has  been  indicated  by  almost  all  authors,  viz.  cold.  It  is 
scarcely  astonishing,  then,  that  cases  of  hsemoglobinuria  should  be 
particularly  frequent  during  the  winter,  towards  the  end  of  autumn, 
and  in  spring.  Nevertheless  it  may  also  be  seen  at  other  seasons  pro- 
vided the  temperature  suddenly  falls,  or  if  other  causes  intervene. 

In  general  the  disease  is  favoured  by  a  plethoric  state  of  body  and 
by  rest.  It  may  certainly  affect  animals  in  thin  or  moderate  condition 
which  work  every  day,  not  even  resting  on  Sundays  ;  but  this  is  rare. 
It  more  particularly  attacks  fat  animals  kept  in  ill-ventilated  stables, 
and  which  have  rested  for  one  or  more  days  while  receiving  their 
ordinary  working  rations.  Should  an  animal  thus  prepared  be  taken 
out  or  worked  during  cold  weather,  hsemoglobinuria  may  suddenly 
appear.  Indeed,  it  is  not  even  necessary  that  the  animal  should  be 
taken  out  or  directly  exposed  to  cold ;  sudden  lowering  of  temperature 
in  the  stable  resulting  in  a  chill  is  sufficient.  Some  years  ago  we  had 
a  horse  affected  in  this  way  in  stable  No.  5.  It  first  showed  symptoms 
of  colic,  and  the  real  nature  of  the  disease  was  not  recognised  until  a 
little  later,  when  dark-coloured  urine  was  passed.  Horses  of  all  breeds, 
classes,  and  ages  are  subject  to  hsemoglobinuria,  though  it  seems  par- 
ticularly to  affect  heavy  animals  of  plethoric  temperament,  which  con- 
sume large  quantities  of  oats,  and  animals  during  the  most  vigorous 
years  of  life. 

This  explains  both  the  appearance  of  the  larger  number  of  cases  of 
hsemoglobinuria  during  the  morning  hours  when  cold  is  most  felt,  and 
the  enzootic  character  which  the  disease  sometimes  appears  to  assume 
at  times  when  frost  or  snow  prevent  working ;  large  numbers  of  animals 
which  have  been  subjected  to  the  same  predisposing  influences  being 
attacked  almost  simultaneously,  or  during  the  course  of  a  few  days. 
Hsemoglobinuria  has  even  been  regarded  as  an  infectious  disease,  and 
the  animals  affected  with  it  thought  to  have  undergone  some  change  of 
tissue  or  blood-plasma,  tending  to  prepare  the  way  for  the  supposed 
pathogenic  agent.  Experiments  made  with  the  object  of  verifying  this 
idea  have  not  carried  it  beyond  the  stage  of  an  hypothesis.  Following 
many  others,  I  vainly  attempted  to  transmit  the  disease  to  horses  by 
injecting  under  the  skin  and  into  the  veins  and  peritoneum  defi- 
brinated  blood  and  preparations  from  the  affected  organs.  The 
disease  is  not  contagious,  and  cannot  pass  from  affected  to  healthy 
animals.  In  the  rare  cases  where  contagion  or  external  infection 
have  been  suspected,  the  patients  which  had  been  simultaneously  or 
successively  affected  had  also  been  under  the  same  conditions  of  feed- 
ing, treatment,  and  work. 


HEMOGLOBINURIA    (aZOTURIa)    IN    THE    HORSE.  253 

The  symptomatology  of  hsemoglobinuria  is  somewhat  complex,  and 
this  diversity  in  its  clinical  appearances  has  naturally  given  rise  to  equal 
divergence  of  opinion  as  to  the  nature  of  the  disease.  Nevertheless 
certain  highly  significant  signs  are  never  absent. 

Let  us  first  consider  its  general  characters.  As  I  have  said,  the 
disease  usually  appears  during  work.  Invasion  is  sudden.  At  first  the 
animal  is  more  lively  than  usual  in  proportion  to  the  length  of  the  pre- 
ceding rest,  but  suddenly  becomes  uneasy,  and  exhibits  visibly  increas- 
ing anxiety  or  colicky  pains  ;  its  pace  slackens  ;  rigors,  trembling,  and 
localised  or  general  sweating  occur  ;  respiration  is  quickened,  sometimes 
groaning,  or  rather  oppressed  ;  the  face  appears  anxious,  the  nostrils 
dilated,  the  eye  brilliant ;  at  this  time,  or  very  soon  after,  movement 
becomes  difficult.  In  most  cases  these  primary  symptoms  occur  ten 
minutes  or  a  quarter  of  an  hour  after  the  animal  quits  the  stable  ;  in 
others  at  the  end  of  a  quarter  of  an  hour  to  one  hour,  sometimes  even 
later.  When  the  animal  is  attacked  in  the  stable  or  while  being 
harnessed,  symptoms  of  excitement,  stamping,  rapid  movement  of  the 
flank,  and  anxiety,  followed  by  sweating,  are  noted.  When  the  animal 
is  started  or  walked  about  in  order  to  ease  the  colic  from  which  it  is 
supposed  to  be  suffering,  it  moves  with  difficulty,  as  in  the  preceding 
case. 

The  interference  with  movement,  one  of  the  two  chief  symptoms  of 
the  disease,  is  variable  in  form,  localisation,  and  intensity.  Sometimes 
it  appears  as  generalised  or  localised  stiffness  in  the  hind  quarters,  like 
that  due  to  muscular  rheumatism  ;  sometimes  it  resembles  paralysis, 
usually  limited  to  the  hind  quarters  ;  the  hind  legs  seem  paralysed, 
yield  under  the  body-weight,  and  are  only  moved  with  great  difficulty, 
the  toe  being  dragged  or  the  fetlock  even  coming  in  contact  with  the 
ground.  In  a  number  of  cases  the  hind  limbs  are  unequally  affected, 
or  only  one  may  be  attacked.  Some  authors  claim  to  have  noted  that 
the  left  hind  limb  is  more  often  the  seat  of  disease  than  the  right. 
This,  however,  is  only  accidental  :  of  eighteen  cases  of  paralysis  of  a 
single  hind  limb  which  I  examined,  ten  were  of  the  right  and  eight  of 
the  left  side.  Sometimes,  but  much  more  rarely,  one  or  both  of  the 
fore-limbs  may  be  affected.  The  muscles  neighbouring  or  antagonistic 
to  those  paralysed  may  show  contraction.  To  such  contraction  is  due 
the  rigidity  of  the  neck,  the  stiffness  and  lifting  of  the  tail,  and  the  pain- 
ful tension  in  certain  muscles  of  the  abdomen  and  limbs. 

Symptoms  of  paresis,  however,  predominate,  and  sometimes  increase 
with  alarming  rapidit}^  When  the  hind  quarters  are  affected  para- 
plegia soon  becomes  more  or  less  complete  ;  the  animals  are  unable  to 
stand,  appear  excited,  and  vainly  struggle  to  rise. 


254  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

In  the  great  majority  of  cases  this  failure  of  motor  power,  whether  or 
neuropathic  or  myopathic  origin,  is  accompanied  by  multiple  localised 
inflammation  of  muscle,  evidenced  by  circumscribed  or  diffuse  swellings. 
In  some  a  large  portion  of  the  muscular  system  is  affected  ;  in  most  the 
myositis  is  local,  affecting  either  superficial  or  deep-seated  muscles. 
No  region  is  exempt,  though  change  is  most  frequent  in  the  muscular 
tissues  of  the  croup,  quarters,  buttocks,  lumbar  region,  back,  shoulders, 
neck,  and  chest.  The  appearances  are  as  follows  : — Swelling  of  variable 
extent  and  size,  produced  by  tumefaction  of  the  muscles,  which  are  felt 
to  be  dense,  hard,  painful,  tense,  and  sometimes  a  little  oedematous  ;  the 
skin  covering  them  is  warm,  sensitive,  and  adherent ;  sensation  gradu- 
ally diminishes,  but  complete  anaesthesia  is  rare.  These  localised  in- 
flammations may  persist  and  become  accentuated,  may  gradually 
diminish  and  disappear  without  leaving  traces,  or  may  be  followed  by 
degenerative  changes,  producing  atrophy  of  certain  of  the  affected 
muscles. 

The  second  chief  symptom  of  hsemoglobinuria  is  melanuria — 
blackish  or  very  deep  coloration  of  the  urine, — a  change  due  to  the 
presence  of  a  certain  quantity  of  haemoglobin  and  of  methaemoglobin. 
This  symptom,  which  is  almost  always  constant,  corresponds  in 
intensity  with  that  of  the  disease  itself.  The  urine  may  exhibit  an 
entire  series  of  intermediate  tints  between  light  red  and  black.  Most 
frequently  the  first  urine  passed  is  brownish  or  black,  like  liquid  manure, 
and  in  fatal  cases  remains  in  this  condition  ;  in  others  it  gradually 
becomes  lighter.  This  urine  contains  a  varying  quantity  of  haemo- 
globin, and  an  excess  of  urea  and  various  other  metabolic  products. 
It  also  shows  a  considerable  proportion  of  albumen  (as  high  as  three 
drachms  to  the  pint),  desquamated  epithelial  cells,  leucocytes,  red 
blood-corpuscles,  cylindrical  casts,  and  sometimes  a  little  glucose.  It 
retains  the  normal  alkaline  reaction,  though  this  becomes  less  when 
the  kidneys  are  diseased.  As  long  as  the  patient  can  stand,  micturition 
occurs  easily,  but  when  the  patient  is  lying  helpless  it  is  generally 
suppressed. 

The  changes  occurring  in  other  bodily  organs  are  less  important. 
I  have  mentioned  colic,  with  or  without  the  passage  of  soft  faeces, 
which  occurs  at  the  outset ;  at  a  later  stage  the  peristaltic  action  of 
the  bowel  diminishes  in  frequence  and  power ;  constipation  may  exist ; 
defecation  is  suspended  ;  the  appetite  is  usually  moderate,  but  thirst 
excessive.  The  respiration,  which  is  more  or  less  accelerated  during 
the  first  minutes  of  the  attack,  soon  becomes  rapid,  panting,  and  in 
most  cases  oppressed ;  in  animals  which  struggle  violently  it  may  rise 
to  60  or  80  per  minute.     The  circulation  is  sometimes  comparatively 


h/i<:moglokinuria  (azoturia)  in  thp:  horse.  255 

little  disturbed,  but  struggling  causes  a  steady  rise  in  the  pulse ;  the 
latter  is  at  first  full  and  strong,  but  later  becomes  feeble,  and  in  cases 
almost  imperceptible.  The  mucous  membranes,  particularly  the  con- 
junctivae, are  injected  and  purplish.  In  many  patients  the  temperature 
remains  normal,  or  only  rises  a  few  tenths  of  a  degree  ;  in  twenty  out 
of  twenty-five  cases  Friedberger  and  Frohner  found  no  fever  whatever. 
Nevertheless  the  temperature  may  rise  considerably,  sometimes  more 
than  2°  C.  You  must  understand  that  the  absence  of  fever  in  no  way 
justifies  one  in  regarding  the  disease  as  benign  ;  very  grave  cases,  indeed, 
may  remain  absolutely  without  fever. 

Apart  from  the  loss  of  power  in  the  hind  limbs  and  the  local  con- 
tractions mentioned,  other  nervous  symptoms  occur,  including  paralysis 
of  the  tail,  rectum,  and  bladder.  When  the  kidneys  become  gravely 
affected,  and  no  longer  perform  their  function  of  purifying  the  blood, 
symptoms  of  uraemia  appear.  The  most  striking  are  epileptiform  con- 
vulsions, attacks  of  dyspnoea,  and  generalised  cramp,  alternating  with 
periods  of  coma,  and  later,  profound  depression  of  the  bodily  forces  and 
gradual  sinking  of  temperature. 

To  this  summary  of  the  symptoms  which  may  appear  at  various 
stages  of  haemoglobinuria  I  wish  to  add  a  few  words  regarding  the  two 
principal  clinical  divisions  of  the  disease.  Considered  from  the  point 
of  view  of  its  development,  course,  and  terminations,  we  recognise  (i) 
a  rapidly  progressive  form,  accompanied  by  paralytic  symptoms  ;  and 
(2)  a  benign  form,  in  which  the  disease  process  quickly  subsides  without 
producing  paralysis. 

In  the  paralytic  form,  which  is  most  common,  paralysis  of  a  limb,  or 
of  both  hind  quarters,  may  be  noted  within  ten  minutes,  a  quarter  of 
an  hour,  or  half  an  hour  after  the  appearance  of  the  first  symptoms. 
Patients  with  paraplegia  fall  to  the  ground  in  spite  of  all  their  efforts 
to  remain  standing,  and  on  attempting  to  rise  are  only  able  to  lift  the 
fore-parts  of  the  body  ;  the  hind  parts  remain  powerless.  During  the 
first  few  hours  they  show  signs  of  excessive  excitement ;  the  skin  is 
damp  with  sweat,  and  steams ;  the  respiration  is  rapid  and  panting, 
the  pulse  frequent  and  strong,  the  conjunctiva  purplish.  Sometimes 
these  symptoms  persist ;  sometimes  they  gradually  diminish  in 
intensity ;  a  quiet  period  occurs,  the  sweating  ceases,  the  breathing 
and  circulation  are  less  rapid  ;  everything  points  to  real  improvement. 

When  the  issue  is  likely  to  prove  favourable  this  calm  period  con- 
tinues, and  in  from  twenty-four  hours  to  six  or  eight  days — usually  on 
the  second  to  the  fifth  day — recovery  takes  place.  Sometimes  it 
occurs  as  suddenly  as  the  attack.  A  patient  which  the  evening  before 
was  lying  helpless  is  next  morning  found  standing  at  the  manger. 


256  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

The  most  frequent  after-complications  are  bedsores,  areas  of  dry 
gangrene  over  the  most  prominent  portions  of  the  body,  consequent  on 
the  animal  remaining  too  long  in  one  position,  and  localised  atrophy 
of  certain  groups  of  muscles,  particularly  of  the  crural  muscles,  conse- 
quent on  myositis  or  neuritis.  Sometimes  the  hind  limbs  show  a  kind 
of  paresis  due  to  myelitis  or  to  spinal  meningitis. 

When  the  end  is  likely  to  prove  fatal,  the  grave  earlier  phenomena 
persist  with  but  slight  and  short  remissions,  or  the  improvement  is 
soon  followed  by  a  return  of  the  symptoms,  which  are  prolonged  until 
death  occurs.  The  latter  is  produced  either  by  slow  asphyxia,  conse- 
quent on  pulmonary  congestion,  or  by  uraemia  or  cardiac  syncope.  In 
some  cases  the  course  is  very  rapid,  the  symptoms  extremely 
alarming  from  the  first ;  the  animal  struggles  violently,  the  chief 
functions  are  greatly  accelerated,  the  respiration  especially  being 
hurried  and  accompanied  by  frequent  groaning;  the  mucous  mem- 
branes become  purple  and  the  limbs  cold.  Before  the  end  of  the  first 
day — sometimes  after  a  few  hours — death  occurs  during  a  violent 
attack  of  struggling,  or  preceded  only  by  a  few  convulsions.  Some 
years  ago  we  saw  these  symptoms  of  acute  hsemoglobinuria  in  a  patient 
which  died  in  ten  hours. 

The  benign  form,  with  or  without  myositis,  is  characterised  only  by 
trifling, general  disturbance  and  more  or  less  marked  difficulty  in  move- 
ment ;  the  gait  is  stiff,  awkward,  and  painful ;  the  limbs  are  momentarily 
flexed  ;  one  or  another  sometimes  shows  temporary  lameness.  These 
symptoms  very  rapidly  diminish  and  disappear.  Resolution  is  gener- 
ally announced  by  the  passage  of  dark  urine.  Sometimes  the  urine  is 
scarcely  red  in  colour,  or  may  even  appear  normal. 

After  recovery  a  predisposition  to  fresh  attacks  remains.  In  this 
respect  haemoglobinuria  resembles  rheumatic  affections.  One  animal 
may  undergo  several  attacks  during  a  few  weeks.  M.  Lucet  mentions 
a  horse  which  had  three,  separated  by  intervals  of  ten  and  five  days. 
This  recurring  character  has  procured  for  the  disease  the  name  of 
periodic  or  intermittent  hsemoglobinuria. 


XXXV.— HEMOGLOBINURIA    (AZOTURIA)    IN    THE 
HORSE    (CONCLUSION). 

The  most  constant  and  important  anatomical  changes  in  haemo- 
globinuria  are  to  be  found  in  the  blood  and  muscles. 

As  a  rule  the  blood  is  not  coagulated,  or  is  diffluent,  blackish,  and 
gummy.  Even  during  life  it  appears  to  have  undergone  change  ; 
withdrawn  from  the  jugular  \'ein  into  a  suitable  vessel  it  usually 
coagulates  slowl}- :  sometimes  the  serum  is  reddish  in  colour,  due  to 
a  certain  amount  of  dissolved  haemoglobin  ;  sometimes  it  contains 
crj'stals  of  hasmatoidin.  Chemical  analysis  reveals  a  high  proportion 
of  urea  and  other  metabolic  products :  the  alkalinity  is  diminished. 
On  microscopic  examination  most  of  the  red  blood-corpuscles  show  the 
usual  physiological  characters,  but  some  are  changed,  deformed,  and 
irregular. 

The  majority  of  the  muscles  affected  with  myositis  are  swollen, 
pale,  whitish,  or  yellowish  white,  and  more  or  less  infiltrated  with 
serum  ;  those  recently  affected  are  hypersemic.  Incisions  made  parallel 
with  the  fibres  demonstrate  the  existence  of  blood  effusions  or  of 
ecchymoses.  These  lesions,  regarded  by  some  authors  as  primary  and 
by  others  as  secondary,  are,  as  I  have  mentioned,  specially  marked  in 
the  muscles  of  the  hind  quarters.  As  described  by  M.  Arloing  in  1866, 
the  muscular  fibres  show,  on  microscopic  examination,  the  changes, 
peculiar  to  acute  degenerative  myositis — cloudy  swelling,  loss  of  or 
diminution  in  the  clearness  of  their  striation,  fragmentation  of  the 
fibres,  hyaline  or  granulo-fatty  degeneration ;  the  interstitial  tissue 
often  contains  masses  of  red  blood-corpuscles.  In  most  cases  the 
kidneys  seem  affected  with  parenchymatous  nephritis  ;  they  are  large,. 
h3'persemic,  and  ecchymosed  ;  on  section  the  cortical  substance  appears, 
moderately  congested,  marked  with  haemorrhagic  streaks  and  points  ; 
the  medullary  substance  is  reddish  jellow,  and  more  or  less  infiltrated.. 
These  lesions,  however,  are  sometimes  far  from  pronounced.  Under 
the  microscope  a  granular  exudate  is  seen  in  the  glomeruli  and  urini- 
ferous  tubules  ;  sometimes  the  epithelium  of  the  convoluted  tubes  is. 
much   infiltrated  with   pigment.      Without   being  absolutely  constant,, 

R 


258  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

congestive  and  haemorrhagic  lesions  in  the  nervous  centres,  particularly 
in  the  lumbar  portion  of  the  cord  and  in  certain  nerves,  notably  the 
femorals,  are  rarely  absent.  In  addition  I  should  mention  the  con- 
gestive lesions  in  certain  portions  of  the  intestinal  mucous  membrane, 
the  swelling  and  haemorrhages  in  the  spleen,  the  fatty  degeneration  of 
the  liver  and  other  glands,  and  the  hyperaimia  of  most  of  the  viscera 
and  of  the  bone  marrow. 

These  appearances  are  in  great  part  consequent  on  changes  in  the 
blood,  and  on  the  uraemia  which  complicates  prolonged  cases. 

The  pathogeny  of  haemoglobinuria  is  variously  interpreted.  The 
most  recent  work  published  on  this  question  does  not  appear  to  have  in 
any  appreciable  degree  advanced  it. 

In  the  nervous  or  medullary  theory,  accepted  by  many  writers  and 
remarkably  well  described  by  M.  Trasbot  in  the  A  7xhives  Veterinaircs, 
the  symptoms  noted  are  referred  to  congestion  of  the  spinal  cord  or  to 
myelitis.  Unquestionably  the  cord  often  shows  hypenemic  and 
hsemorrhagic  changes,  but  it  may  well  be  asked  whether  these  are  not 
due  to  the  same  causes  as  the  secondary  changes  in  the  viscera ;  many 
persons  maintain  that  they  are  not  constant,  and  certainly  they  explain 
neither  hasmoglobinaemia  nor  hsemoglobinuria.  In  two  post-mortem 
examinations  made  during  the  last  few  years  the  cord  appeared  to  me 
unchanged  on  naked-eye  examination,  and  the  microscope  showed  no 
important  lesions.* 

xVuthors  have  at  various  times  traced  the  disease  to  congestion  of 
the  kidneys  or  to  nephritis.  The  waste  products  usually  excreted  by 
the  kidneys  are  said  to  produce  general  intoxication,  changes  in  the 
blood-corpuscles,  inflammation  of  muscle,  and  the  train  of  symptoms 
which  successively  appear.  M.  Lucet,  who  regards  haemoglobinuria  as 
a  disease  of  renal  origin,  refers  the  benign  cases  to  an  ephemeral  but 
■excessively  acute  nephritis.  But  renal  changes  appear  to  be  always 
secondary,  consecutive  to  changes  in  the  blood.  Lesions  in  the  epithelial 
cells  lining  the  renal  tubules,  like  enlargement  and  pigmentation,  are  said 
to  be  caused  by  the  elimination  through  the  kidney  of  products  resulting 
from  destruction  of  red  blood-corpuscles,  or  the  transformation  of 
haemoglobin.  Experiments  carried  out  in  company  with  M.  Roger 
have  satisfied  me  that  urinary  intoxication  produced  by  injecting  fresh 
filtered  urine  into  the  horse's  jugular  produces  none  of  the  symptoms 

*  111  his  treatise  on  nervous  affections  in  the  horse,  just  published,  Dexler  regards 
haemogiobinuria  as  a  disease  of  the  cord.  He  states  that  the  dominant  symptoms  are  those 
of  a  medulla-ry  affection,  and  he  claims  to  have  foimd  in  the  anterior  horns  of  the  lumbar 
portion  of  the  cord  lesions  which  explain  these  symptoms. 


H.-KMO(;i.or.iNURiA  (azoturia)  in  the  hoksk.  259 

of  hysmoglobinuria.  W^e  likewise  found  that  blood-serum  from  horses 
affected  with  this  disease  had  no  special  effect  in  destroying  formed 
blood  elements.  Injected  into  the  veins  of  the  rabbit,  it  did  not  seem 
more  distinctly  toxic  than  normal  serum. 

The  theory  that  haemoglobinuria  is  an  infectious  disease  is  not  new. 
In  France  it  was  advocated  by  M.  Signol,  and  particularly  by  M. 
Arloing.  It  better  accounts  for  the  phenomena  occurring  during  the 
course  of  the  affection  than  any  other.  These  are  said  to  result  from 
auto-infection  or  auto-intoxication,  due  either  to  a  ferment  present  in 
the  food  or  to  the  abundant  formation  of  metabolic  products  under  the 
double  influence  of  cold  and  movement  in  animals  predisposed  by 
long  rest  in  the  stable.  It  is  to-day  generally  allowed  that  the  cause, 
whatever  it  may  be,  produces  change  in  the  red  blood-corpuscles, 
destruction  of  a  greater  or  smaller  number,  with  solution  of  their  haemo- 
globin in  the  blood-plasma,  thus  setting  up  hsemoglobinuria,  from  which 
all  the  other  lesions  are  said  to  be  derived.  Against  this  theory  it  is 
urged  that  the  disease  behaves  in  no  wise  like  an  infectious  process, 
that  it  is  not  contagious,  that  all  attempts  at  transmission  have  failed, 
that  blood  removed  aseptically  during  life  does  not  always  give  a 
coloured  or  red  serum  ;  finally,  that  the  metabolic  products  which, 
on  the  theory  of  auto-intoxication,  should  exist  in  large  quantities  in 
the  blood,  are  at  times  only  met  with  in  normal  proportion.  However 
this  may  be,  the  disease  certainly  offers  some  resemblance  to  an  infec- 
tious process,  and  it  would  not  be  surprising  if  one  day  this  view  of 
its  pathology  were  bacteriologically  confirmed.  What  was  known 
fifteen  years  ago  regarding  the  pathogeny  of  tetanus  ?  that  toxi-infectious 
disease  which  can  never  be  transmitted,  so  to  speak,  directly,  and  the 
development  of  which,  like  that  of  haemoglobinuria,  is  so  favoured  by 
cold. 

The  muscular  or  rheumatismal  theory  supported  by  Frohner  com- 
pares haemoglobinuria  of  the  horse  with  paroxysmal  haemoglobinuria  a 
frigore  in  man.  The  principal  cause  of  the  equine  disease  is  said  to  be 
the  action  of  cold  ;  the  essential  and  primary  change  degeneration  in 
certain  muscles,  the  colouring  material  of  which  is  liberated,  and  to- 
gether with  other  substances  passes  into  the  blood,  accumulates  there, 
produces  secondary  lesions  in  the  internal  organs,  and  is  then  elimi- 
nated by  various  emunctories,  especially  by  the  kidney,  whence  the  deep 
coloration  of  the  urine  and  the  nephritis.  The  partisans  of  this  theory 
lay  stress  on  the  fact  that  grave  lesions  almost  always  exist  in  several 
groups  of  muscle,  that  the  sudden  action  of  cold  is  capable  of  rapidly 
producing  change  and  discoloration  of  muscle ;  finally,  that  the  blood 
of  animals  affected  with  haemoglobinuria  contains  an  excessive  proper- 


26o  CIJMCAI,    VKTKRINARV    IMKDICIXE    AND    SLR(;p:K\. 

tion  of  haemoglobin  which  might  originate  from  the  colouring  material 
of  the  altered  muscles. 

The  results  following  attempts  to  produce  experimental  hsemoglo- 
binuria  in  no  way  favour  the  renal  theory.  Hsemoglobin&emia,  with  or 
without  hemoglobinuria,  ma}'  be  produced  b}'  introducing  into  the 
blood  substances  which  cause  destruction  of  a  greater  or  less  number  of 
red  blood-corpuscles,  and  thus  set  at  liberty  varying  quantities  of  haemo- 
globin, capable  of  conversion  into  methaimoglobin  and  many  other  still 
unknown  metabolic  products.  If  few  red  blood-corpuscles  are  destroyed, 
slight  hasmoglobinaemia  without  hemoglobinuria  is  produced  :  hsemo- 
globin  is  soon  broken  up  by  the  liver,  spleen,  and  bone  marrow.  The 
same  result  follows,  even  though  destruction  is  more  abundant,  provided 
it  occurs  gradually  ;  neither  haemoglobinuria  nor  visible  changes  in  the 
kidneys  are  seen.  On  the  contrary,  if  it  is  abundant  and  rapid,  hemo- 
globinuria appears,  and  the  kidneys  undergo  more  or  less  gra\'e  change. 
Hemoglobinemia,  hemoglobinuria,  and  disease  of  the  kidney  constitute 
the  three  stages  of  hemoglobinuria  experimentall}'  produced.  Spontane- 
ous hemoglobinuria  is  very  probably  marked  by  similar  stages.  What 
remains  to  be  discovered  is  the  cause  or  agent  which  in  the  spontaneous 
form  sets  at  liberty  the  hemoglobin. 

The  conditions  under  which  the  disease  appears,  the  sudden  invasion, 
preliminary  colicky  pains,  and  the  multiplicity  of  organs  almost  imme- 
diately affected,  suggest  that  it  results  from  toxic  infection  of  intestinal 
origin,  of  which  the  hemoglobinemia,  hemoglobinuria,  and  the  changes 
in  muscle  and  in  the  spinal  cord  are  only  the  principal  manifestations. 
Not  onl}'  does  the  intestine  present  a  vast  cavity  for  the  growth  of 
pathogenic  microbes  ;  it  is  also  a  centre  of  manufacture  for  toxins. 
Overfeeding  of  horses  while  idle  favours  the  production  of  intestinal 
poisons  ;  and  it  is  known  that  when  associated,  otherwise  relatively 
harmless  germs,  like  the  Bacillus  coli  connnunis,  the  paracoli  bacilli, 
and  the  streptococci,  may  produce  deadly  toxins.  In  processes  of  this 
nature  intoxication  irxa}-  play  an  e\en  more  important  part  than  infec- 
tion.* 

The  diagnosis  of  hemoglobinuria  is  usuall}-  easy.  Nevertheless 
benign  cases  may  at  first  be  mistaken  either  for  intestinal  colic  or  for 
muscular  rheumatism.  Others,  where  the  animal  is  lying  down  when 
examined,  may  suggest  traumatic  paraplegia  or  fracture  of  the  vertebral 

*  M.  Lignieres  found  streptococci  in  the  cerebro-spinal  fluid  of  horses  dead  of  hc-emo- 
globinuria.  This  discovery,  however,  only  shows  that  streptococci,  without  doubt  originating 
in  the  intestine,  had  entered  the  blood-stream.  It  remains  to  be  proved  that  this  was  not  a 
case  of  organisnvs  entering  the  circulation  during  the  death  agonv. 


h.+:mo(;i.obinuria  (azoturia)  in  the  horse.  261 

column  ;  but  the  history  and  red  coloration  of  the  urine  remove  any 
possible  doubt.  The  atrophy  of  muscle  afterwards  seen  in  different 
regions,  most  frequently  in  the  triceps  cruralis  muscle,  can  always  be 
traced  to  hsemoglobinuria.  The  majority  of  other  changes  are  of 
similar  origin.  In  their  case  also  the  history  constitutes  a  valuable 
indication.  A  few  weeks  ago  you  saw  a  case  of  atrophy  of  the  extensor 
muscles  of  the  right  forearm.  The  history  enabled  us  to  trace  this 
lesion  to  an  attack  of  ha^moglobinuria  which  the  animar underwent  last 
winter. 

The  prognosis  varies  considerably  according  to  the  degree  of  acute- 
ness  of  the  disease,  the  localities  it  affects,  and  the  constitution  of  the 
patients.  Statis'tics  show  the  mortality  to  \'ary  between  5  and  70  per 
cent.  Plethoric  horses  which  eat  large  quantities  of  grain,  and  par- 
ticularly of  oats,  are  much  more  liable  to  die  than  animals  accustomed 
to  moderate  feeding.  This  seems  to  me  to  explain  the  marked  gravity 
of  hsemoglobinuria  in  town  horses,  and  the  series  of  recoveries  reported 
by  veterinary  surgeons  who  practise  in  country  districts.  It  is  also 
clear  that  certain  authors  have  mistaken  infectious  forms  of  paraplegia 
which  are  seen  in  all  countries,  and  everywhere  cause  heavy  mortality, 
for  haemoglobinuric  paralysis.  Benign  character  of  the  first  symptoms, 
slow  development  of  the  disease,  preservation  of  the  standing  position, 
normal  or  but  slightly  modified  rhythm  of  the  chief  functions  of  the 
body,  and  continuance  of  the  evacuations,  are  signs  justifying  a  favour- 
able prognosis.  On  the  other  hand,  sudden  invasion,  marked  accelera- 
tion of  breathing,  abundant  sweating,  high  fever,  paraplegia,  and 
cessation  of  the  evacuations,  leave  little  ground  for  hope.  I  should 
add  that  in  some  cases  the  disease  develops  insidiously,  and  that  though 
at  first  benign  it  may  at  any  moment  be  accompanied  by  paralysis. 
For  this  reason  a  certain  reserve  should  be  exercised  in  speaking  of 
cases  which  even  appear  likely  to  recover.  Prognosis  is  always  un- 
favourable in  cases  affected  with  paraplegia.  When  this  persists  beyond 
the  third  day  the  issue  is  generally  fatal. 

Prophylaxis  is  founded  on  our  knowledge  of  the  aetiology.  Avoid, 
as  far  as  possible,  leaving  horses  too  long  in  the  stable ;  exercise  them 
for  at  least  a  few  minutes  night  and  morning  on  resting  days  ;  always 
proportion  food  to  the  work  to  be  done ;  reduce  the  rations  during  rest, 
improve  the  animal's  hygienic  surroundings,  paying  especial  attention 
to  securing  uniform  temperature,  sudden  changes  in  which  may  have 
particularly  injurious  effects. 

I  have  said  that  the  disease  generally  appears  during  work,  and  is 
rapidly  aggravated  by  attempts  to  draw  a  load  even  at  a  walking  pace. 


262  CLINICAL    VETKRINARV    MEDICINK    AND    SURGER'S'. 

As  soon,  therefore,  as  the  animal  is  seen  to  be  ill  it  should  be  stopped, 
taken  out  of  the  shafts,  and  removed  to  a  neighbouring  stable,  or 
placed  in  an  ambulance  and  taken  home.  Arrived  there  it  can  be 
placed  in  a  box,  where  it  should  be  kept  warm  and  quiet.  Animals  do 
better  if  able  to  stand,  for  which  reason  slinging  may  prove  useful.  If, 
however,  the  patient  is  totally  incapable  of  standing  even  with  slings, 
it  should  be  given  a  thick  bed  of  straw. 

The  present-  uncertainty  regarding  the  nature  of  haemoglobinuria 
renders  treatment  hesitating.  As  in  all  diseases  in  which  the  essential 
cause  is  unknown,  a  large  number  of  methods  and  innumerable  drugs 
have  been  recommended.  Many  are  only  injurious,  but  some  are  of 
real  value.  While  combating  the  more  marked  disease  symptoms,  the 
general  line  of  treatment  should  resemble  that  prescribed  against  toxic 
infections. 

In  the  grave  form — especially  when  dyspnoea  is  marked — ^bleeding 
may  be  practised,  seven  to  fourteen  pints  of  blood  being  removed 
according  to  the  animal's  size.  This  constitutes  a  first  method  of 
removing  the  poisons,  microbic  or  cellular.  Whether  disease  be  trifling 
or  severe,  attempts  should  be  made  to  secure  an  action  of  the  bowels 
by  administering  a  hypodermic  injection  of  2  to  4  centigrammes  of 
hydrobromate  of  arecolin,  5  to  10  centigrammes  of  sulphate  of  eserine, 
or  10  to  20  centigrammes  of  hydrochlorate  of  pilocarpine.  The  body 
and  limbs  can  afterwards  be  briskly  rubbed  with  flannel  or  with  straw 
wisps.  If  necessary  the  hypodermic  injection  can  be  repeated  on  the 
following  days. 

Lafosse,  Colin  (de  Vassy),  Jouquan,  and  some  other  veterinarians 
have  recommended  continuous  refrigeration  of  the  dorso-lumbar  region 
by  irrigation,  or  by  applying  wet  cloths  frequently  moistened  with  cold 
water.  This  is  one  method  of  treating  the  myositis  and  congestion  of 
the  spinal  cord. 

Sometimes  excitement  is  severe.  The  emimal  struggles  violently,  is 
covered  with  sweat,  and  the  body  is  severely  bruised  by  striking  against 
the  ground.  This  excessive  excitement  should  be  combated  by  nar- 
cotics and  anaesthetics.  If  water  is  readily  taken,  laudanum  should  be 
added  to  it  ;  but  if  refused,  morphine  should  be  subcutaneously  injected, 
or  chloral  given  in  a  ball.  The  animal  must  be  frequently  turned  over 
and  provided  with  a  good  bed,  both  to  prevent  hypostatic  congestion 
and  the  formation  of  bedsores  on  prominent  parts  of  the  body. 

When  appetite  is  preserved,  or  when  it  returns,  the  animal  should 
be  supported  on  gruel  and  milk.  It  may  also  be  given  green  food,  ha}-, 
and  a  small  quantity  of  oats. 

In  addition  to  the  alkaloids  alread}-  mentioned,  internal  medication 


H.E.MOC.LOHINURIA    (aZOTURIa)    IN    THK    HORSE.  263. 

comprises  administration  of  purgatives  and  alkaline  salts.  Having 
succeeded  at  the  outset  in  producing  one  abundant  evacuation,  the 
action  of  the  bowel  can  be  sustained  by  repeated  doses  of  sulphate  of 
soda.  The  fact  that  the  alkalinity  of  the  blood  is  generally  diminished, 
as  in  infectious  conditions,  and  in  the  various  processes  which  lead  to 
destruction  of  the  formed  elements  of  the  blood,  suggests  the  use  of 
alkalies.  Dickerhoff  recommended  bicarbonate  of  soda  in  daily  doses  of 
six  to  sixteen  ounces,  divided  into  several  parts  and  given  in  the  drinking- 
water  ;  this  dose  was  afterwards  diminished  to  three  or  four  ounces. 
The  remedy  is  simple,  cheap,  and  readily  taken  by  patients,  while  it 
undoubtedly  has  a  favourable  effect.  By  rendering  the  fluids  alkaline 
it  increases  their  bactericidal  and  antitoxic  powers,  and  by  restoring  to 
them  what  the  infection  had  removed,  it  assists  elimination  of  toxins, 
and  fortifies  the  red  blood-corpuscles.* 

Stimulants  are  now  almost  abandoned,  their  action  having  been 
found  to  be  highly  injurious.     Alteratives  have  no  value. 

When  the  animal  remains  recumbent  for  long  periods  it  must  not 
only  be  repeatedly  turned  over,  but  the  rectum  and  bladder  must  be 
emptied.  Needless  to  say,  in  passing  the  catheter  full  antiseptic  pre- 
cautions must  be  taken  to  avoid  infecting  the  bladder. 

During  convalescence  alkalies  should  still  be  continued  even  after 
the  administration  of  tonics  has  been  commenced. 

Bedsores  are  treated  with  antiseptic  lotions  containing  sublimate, 
carbolic  acid,  or  iodine,  and  with  applications  of  boric  ointment. 

Soon  after  convalescence  is  established  the  animals  may  return  to 
light  work,  being  guarded,  however,  against  chills  which  might  lead  to 
relapse,  and  be  very  gradually  brought  into  their  usual  work. 

The  muscular  lesions  seen  after  attacks  of  haemoglobinuria  seldom 
prove  permanent.  The  affected  muscles  sometimes  recover  their 
normal  size  and  strength  under  the  influence  of  work.  Should  atrophy 
become  more  marked,  however,  the  parts  may  be  fired,  or  irritant  solu- 
tions like  those  of  veratrine  or  chloride  of  sodium  injected  over  the 
affected  region.     The  faradic  current  is  worthy  of  trial. 

The  painful  and  obstinate  lameness  which  follows  paralysis  of  the 
triceps  cruraHs,  and  forms  the  commonest  complication,  may  necessi- 
tate firing  of  the  parts  and  continued  exercise.  By  persevering  in  this 
way  the  muscle  usually  regains  its  power  and  the  lameness  disappears. 

*  M.  Masoin  found  that  alkaline  salts  exercise  a  prophylactic  action  against  intoxications 
caused  by  substances  which  tend  to  destroy  formed  blood  ehments,  and  produce  formation 
of  methjemoglobin.  At  the  same  time  they  exercise  a  general  antitoxic  action.  Their  use 
is  therefore  indicated,  not  only  in  the  curative  treatment  of  haemoglobinuria,  but  in  its  pro- 
phylaxis in  conjunction  with  other  preventive  measures,  thevalue  of  which  has  been  recog- 
nised by  observation. 


XXXVL— DIABETES    MELLITUS    IN    THE    DOG. 

Among  dogs  brought  for  advice  or  left  in  hospital  during  the  past 
few  months  you  have  seen  several  diabetic  patients ;  one  affected  with 
diabetes  mellitus,  the  others  with  simple  polyuria  or  diabetes  insipidus. 
While  the  second  form  is  usually  benign,  the  other — diabetes  mellitus — 
is  a  grave  affection,  which  almost  always  proves  rapidly  fatal.  Up  to 
the  present  time  it  has  been  but  little  studied  in  animals.  I  have 
chosen  it  as  the  subject  of  to-day's  lecture. 

Mentioned  by  Leblanc  in  theCliniqite  Vctcvinaire  for  iS6i,  and  seen 
in  most  of  the  domestic  animals,  including  both  ruminants  and  carni- 
vorae,  diabetes  mellitus  is  unquestionably  a  rare  disease,  though  the 
chief  reason  that  veterinary  publications  contain  so  few  recorded  cases 
is  less  connected  with  the  rarity  of  the  disease  than  with  the  fact  that 
examination  of  the  urine  is  habitually  neglected,  and  hence  the 
disease  escapes  observation.  During  the  past  few  years  the  recorded 
cases  of  diabetes  mellitus  in  the  dog  have  increased.  Frohner  at  the 
Veterinary  School  of  Berlin,  and  Schindelka  at  that  of  Vienna,  have 
noticed  several.  Eber,  who  was  specially  entrusted  with  the  clinique 
for  small  animals  at  the  Berlin  School,  has  made  researches  on  the  fre- 
quence of  diabetes  mellitus  in  the  dog.  Within  two  years  about 
20,000  patients  were  brought  for  examination  or  treated  in  the  hospital, 
among  which  Eber  noted  twelve  grave  cases  marked  by  well-dehned  clini- 
cal symptoms,  that  is  about  one  diabetic  patient  among  2000  animals. 
The  disease  is,  however,  certainly  more  common  than  these  statistics 
would  seem  to  indicate ;  trifling  and  recent  or  obscure  attacks  of 
diabetes,  unaccompanied  by  very  evident  disturbance,  either  fail  to 
attract  attention  or  remain  unrecognised. 

I  will  shortly  describe  our  last  case  of  this  kind. 
During  the  first  week  of  May  a  person  living  in  the  Avenue  Kleber, 
at  Paris,  brought  a  five-year-old  bitch  which  had  been  ill  for  three 
months.  Although  she  regularly  ate  her  food  with  good  appetite  this 
bitch  was  distinctly  thin.  She  drank  often  and  copiously,  sometimes 
vomited  after  having  lapped  a  large  quantity  of  water  ;  and  finally  she 


ItlAHIiTES    MELLITUS    IN    THE    l)0(;.  265 

micturated  frequently  and  in  large  quantities.  M.  x\lmy  examined  her 
carefully,  and  finding  no  signs  of  any  organic  disease  which  would  ex- 
plain the  symptoms,  suspected  diabetes.  The  urine  was  analysed  by 
M.  Lesage,  and  found  to  contain  6*25  grammes  of  sugar  per  100.  The 
owner  refused  to  leave  the  patient  in  hospital.  "  As  often  happens, 
the  special  interest  we  showed  in  her  aroused  the  suspicions  of  the 
owner,  who  feared  that  his  animal  would  be  made  the  subject  of  experi- 
ment. 

I  will  give  a  summary  of  the  cases  published  by  Eber  in  1897  in  the 
Monatshcftc  filr  Thicrhcilkundc. 

Case  i. — A  seven  and  a  half-}'ear-old  water-spaniel.  For  six  months 
had  suffered  from  disturbance  of  vision,  marked  thirst,  and  excessive 
appetite. 

Condition  on  Examination. —  Moderately  nourished;  conjunctiva 
rose-red  ;  pulse  regular,  of  normal  force,  eighty  per  minute  ;  respiration 
normal ;  appetite  good  ;  abdomen  swollen  over  the  hypochondriac 
region  ;  margins  of  the  liver  perceptible  two  finger-breadths  from  the 
last  ribs;  double  cataract;  temperature  38*8°  C  (ioi'8°  F.)  ;  polyuria  ; 
urine  light  yellow,  pale,  exhaling  an  odour  of  acetone,  acid  ;  specific 
gravity  i'042  ;  contained  7  per  cent,  of  glucose. 

Treatment. — Meat  diet.  Three  small  doses  of  tincture  of  valerian 
daily.     Died  on  the  sixth  day  in  a  state  of  collapse. 

Case  2. — Cross-bred  nine-year-old  water-spaniel.  Same  history  as 
the  first  patient. 

Condition  on  Examination. — \'ery  marked  wasting  ;  both  lenses 
opalescent ;  margin  of  the  liver  perceptible  behind  the  costal  carti- 
lages ;  urine  pale  yellow,  acid  ;  specific  gravity  1*040  ;  contained  6'5  per 
cent,  of  glucose. 

Returned  a  month  later.  Despite  careful  dieting  wasting  had  in- 
creased ;  urine  contained  7  per  cent,  of  glucose. 

Case  3. — Eleven-year-old  Basset  hound.  Same  history  as  in  the 
preceding  cases. 

Condition  on  Examination. — Wasting  ;  opalescence  of  both  lenses  ; 
enlarged  liver;  urine  clear,  pale  yellow,  acid;  specific  gravity  1*036; 
contained  7  per  cent,  of  glucose.     Patient  was  not  afterwards  seen. 

Case  4. — Ten-year-old  Basset  bitch.  Severe  thirst.  Three  weeks 
•ago  both  lenses  became  opalescent. 

Condition    on    Examination. —  Moderatelv    well    nourished;     double 


266  CI>INICAI,    VKTKRINARV    iMKDICINK    AND    SURtlKRV. 

cataract ;  liver  enlarged  ;  urine  light  yellow,  transparent,  acid  ;  density 
1*036  ;  contained  8  per  cent,  of  glucose. 

Case  5.— Nine-year-old  poodle.     Usual  history. 

Condition  on  Examination. — Somewhat  frequent  coughing ;  chronic 
bronchitis  ;  double  cataract ;  no  enlargement  of  the  liver  ;  urine  cloudy, 
clay-coloured,  bearing  in  suspension  little  yellowish-grey  flocculi  ; 
specific  gravit}'  i"024,  acid,  contained  a  little  albumen  ;  no  bile  pig- 
ments ;  2'6  per  cent,  of  glucose.  On  microscopic  examination  of  the 
urine  numerous  epithelial  cells,  a  few  very  granular  cylindrical  casts, 
some  red  blood-corpuscles,  and  leucocytes  were  discovered. 

Case  was  not  afterwards  seen. 

Case  6. — Ten-j-ear-old  pug.  Left  in  hospital.  No  history.  En- 
larged liver  and  cataract.  The  urine  contained  a  large  proportion  of 
glucose.     No  quantitative  analysis  made. 

Case  7. — Twelve-year-old  water-spaniel.  Usual  histor}'.  Blindness 
had  been  complete  for  a  week. 

Condition  on  Examination. — Bilateral  cataract  ;  lenses  of  a  }-ellowish 
colour ;  liver  enlarged ;  deafness ;  impaired  sense  of  smell ;  urine  pale 
yellow,  acid,  specific  gravit}-  i"042  ;  contained  2"5  per  cent,  of  glucose. 

Treatment. — Careful  diet  and  administration  of  bicarbonate  of  soda. 

Brought  back  four  months  later  to  be  operated  on  for  cataract.  At 
this  date  the  urine  was  albuminous,  but  only  contained  traces  of  sugar  ; 
heart  normal.  After  operation  on  one  eye  the  animal  fell  into  a 
comatose  condition,  and  died  four  days  later. 

Case  8. — Nine-year-old  pug.  Polyuria  ;  excessive  thirst ;  wasting  ; 
vision  impaired  for  the  past  six  weeks. 

Condition  on  Examination. — Opacity  of  both  lenses;  enlargement  of 
the  abdomen,  resembling  abdominal  dropsy.  The  li\'er  extended  more 
than  a  hand's  breadth  beyond  the  last  ribs ;  weakness  and  wasting  ; 
urine  light  yellow,  slightly  albuminous,  slightly  acid,  specific  gravit}' 
i*03i  ;  contained  9*4  per  cent,  of  glucose. 

Case  9. — Nine-year-old  terrier.     Usual  history. 

General  Condition. — Badly  nourished ;  diffuse  cloudiness  of  both 
lenses;  enlarged  li\'er ;  urine  straw-coloured,  slightly  turbid,  and  acid, 
density  i'039  !  contained  a  little  albumen  and  mucin  in  addition  to  8 
per  cent,  of  glucose. 


DIABETES    MELLITUS    IN    THE    DOC;.  267 

Case  io. — Six-year-old  pug.  Had  fallen  away  in  condition,  and  ex- 
hibited cough  for  a  month.  Appetite  great  and  thirst  acute.  No  dis- 
turbance of  vision. 

General  condition  bad.  Slight  diffuse  cloudiness  of  both  lenses ; 
liver  enlarged ;  urine  light  'yellow,  acid,  with  an  intense  smell  of  ace- 
tone, density  i"044,  contained  7  per  cent,  of  glucose;  saliva  alkaline  ; 
little  albumen. 

Case  ii. — Twelve-year-old  Pomeranian  bitch.  For  the  previous  four 
months  had  appeared  depressed  and  tired  ;  appetite  had  fallen  off  during 
the  last  few  days  ;  thirst  very  severe  ;  polyuria ;  animal's  skin  exhaled  a 
foetid  smell.  No  visual  disturbance.  Moderately  nourished.  Trifling 
opacity  of  both  lenses.  The  liver  was  not  swollen  ;  urine  pale,  trans- 
parent, acid,  and  gave  off  an  intense  odour  of  acetone,  density  i'033, 
contained  traces  of  albumen,  and  8  per  cent,  of  glucose  ;  saliva 
alkaline. 

Case  12. — Eight-year-old  Basset  bitch.  Intense  thirst  ;  polyuria 
and  general  wasting.     Appetite  nevertheless  good. 

Condition  on  Examination. — Slight  opacity  of  both  lenses  ;  wasting  ; 
enormous  enlargement  of  the  liver;  urine  clear,  slightly  yellowish,  in- 
odorous, alkaline,  density  1-028,  contained  traces  of  albumen  and  5  per 
cent,  of  glucose  ;  sali\-a  alkaline. 

In  five  diabetic  patients  examined  after  death,  Eber  found  degene- 
rative changes  in  the  liver.  In  one  the  pancreas  was  atrophied  ;  in 
three  it  showed  a  few  greyish  nodules,  the  nature  of  which  was  not 
determined. 

In  man,  in  whom  the  aetiology  of  diabetes  has  been  carefully  studied, 
the  principal  causes  are  said  to  be  improper  or  excessive  food,  abuse 
of  sugary  and  starchy  materials,  sedentar}-  life  or  insufficient  physical 
exercise,  gout ;  finally,  advanced  age.  The  disease  is  oftenest  seen  be- 
tween thirty  and  seventy  years  of  age,  but  may  also  occur  before 
maturity,  during  adolescence,  or  even  in  infancy. 

In  the  dog  diabetes  is  almost  always  confined  to  animals  of  fairly 
advanced  age.  It  is  exceptional  during  the  first  half  of  life.  Of  Eber's 
twelve  patients,  nine  were  more  than  eight  years  old.  The  influence 
of  special  conditions  of  life  is  at  least  as  marked  as  that  of  age.  Almost 
all  cases  are  in  animals  freely  fed,  leading  idle  lives,  or  in  pam- 
pered pet  dogs.  Many  of  these  are  very  affectionate  and  greatly 
attached    to    their    owners  ;    they     become    dull,     ill-tempered,    and 


268  CLINICAL    VETERINAKN     MKDICINK    AND    SURGKKY. 

snappish,  and  although  the  history  always  fails  to  record  the 
fact,  it  may  be  that  excitement  and  emotional  disturbance  play  a 
certain  part  in  developing  the  disease.  M.  Gibier  succeeded  in  pro- 
ducing transitory  glycosuria  in  a  bitch  by  means  of  psychic  excita- 
tion. This  bitch,  which  was  four  years  old,  and  of  a  very  affectionate, 
nervous,  and  jealous  disposition,  lived  free  in  the  laboratory  with  other 
animals  of  its  own  species.  Its  urine,  examined  for  a  period  of  several 
days,  gave  no  reaction.  Shut  up  in  a  cage  the  bitch  appeared  greatly 
■excited.  The  urine  retained  its  normal  character  for  three  daj's,  but 
on  the  fourth  contained  5-55  grammes  of  sugar  per  litre.  The  glyco- 
suria persisted  during  the  entire  period  the  animal  was  shut  up,  but 
disappeared  the  day  after  she  was  set  at  liberty.  Sex  appears  to  have 
no  influence  in  the  aetiology ;  cases  are  as  numerous  in  males  as  in 
females.     Among  Eber's  twelve  patients  were  six  dogs  and  six  bitches. 

Diabetes  in  the  dog  at  first  develops  insidiously,  and  for  a  consider- 
able period  may  produce  no  marked  disturbance.  In  a  number  of  cases 
it  exists  for  months  before  attracting  attention.  As  in  our  patient,  the 
disease  is  not  remarked  until  the  three  principal  symptoms,  polyuria, 
polydipsia  (excessive  thirst),  and  wasting,  are  all  developed. 

Micturition  is  frequent  and  abundant.  Certain  patients  pass  one  or 
even  two  quarts  of  urine  per  day.  Pet  dogs  which  become  diabetic 
are  greatly  inconvenienced,  and  micturate  on  the  carpets  or  cushions  of 
the  rooms  where  they  are  confined.  The  urine  is  usually  limpid,  pale, 
or  light  yellow,  not  infrequently  albuminous,  occasionally  slightly 
turbid,  of  an  average  specific  gravity  of  I'ojo  to  i"040.  It  sometimes 
contains  as  much  as  10  per  cent,  of  sugar.  In  a  twelve-year-old  bitch 
seen  by  Penberthy  the  proportion  was  io"62  per  cent.  As  soon  as  the 
urine  contains  from  3  to  4  grammes  of  glucose  per  litre  it  acquires  a 
sweetish,  sugary  taste. 

Another  important  symptom  is  the  insatiable  thirst  which  troubles 
the  patients.  As  a  consequence  of  the  polyuria  thirst  is  constant, 
though  more  marked  at  certain  times  than  at  others,  being  especially 
acute  during  the  night.  The  mouth  is  dry,  and  the  saliva  tends  to 
become  acid,  so  that  the  gums  are  often  inflamed,  and  the  buccal 
cavity  exhales  a  disagreeable  smell. 

To  the  polyuria  and  polydipsia — the  two  principal  symptoms  of 
diabetes— are  added  weakness  and  wasting,  which  usually  become 
rapidly  aggravated.  Without  being  absolutely  constant,  emaciation  is 
common,  sometimes  appears  early,  and  is  the  more  striking  inas- 
much as  appetite  is  preserved,  or  may  even  be  excessive.  Of  Eber's 
twelve  patients  ten  showed  rapid  wasting.     Enlargement  of  the  liver  is 


DIAHKTES    MELLITUS    IN    THK    I)0(;.  269. 

also  noted  in  almost  all  cases.  Usually  very  marked,  it  produces 
deformity  of  the  abdomen  almost  simulating  ascites,  a  condition  from 
which  it  is  differentiated  by  palpation.  Some  subjects  show  digestive 
disturbance,  particularly  vomiting  and  constipation,  alternating  with 
attacks  of  diarrhcea. 

Cutaneous  complications  like  erythema,  furunculosis,  or  gangrene 
are  occasionally  seen,  as  are  diseases  of  the  respiratory  passages, 
bronchitis,  or  pneumonia  with  a  tendency  to  gangrene  and  tuberculosis. 
They  are,  however,  distinctly  rare.  Disease  of  the  eye,  on  the  other 
hand,  is  very  frequent.  Three  fourths  of  the  dogs  affected  with 
diabetes  suffer  during  the  course  of  the  disease  from  bilateral  cataract, 
which  often  produces  complete  blindness  in  a  few  weeks.  Deafness, 
loss  of  smell,  paralysis,  and  comatose  or  apoplectiform  attacks  may 
also  occur. 

In  diabetic  dogs  examined  after  death  changes  have  been  found  in 
the  liver  and  pancreas-  In  most  cases  the  liver  was  greatl}-  enlarged, 
hypersemic,  and  undergoing  fatty  degeneration  ;  in  some  cirrhosis  was 
also  seen,  but  the  seat  of  the  sclerosing  process  has  not  been  clearly 
described ;  in  a  few  cases  mention  has  been  made  of  atrophic  changes 
in  the  pancreas.  At  the  post-mortem  examination  of  a  bitch  affected 
with  wasting  diabetes,  Lienaux  found  the  liver  undergoing  fatt}- 
degeneration,  and  the  pancreas  atrophied.  The  bitch  examined  by 
Penberthy  showed  similar  lesions  of  the  liver  and  pancreas. 

I  shall  only  sa}-  a  few  words  on  the  pathogen\-  of  diabetes  During 
the  course  of  the  present  century,  but  especialh'  after  the  discoveries 
of  Bernard,  and  more  particularly  during  the  last  twent\-  }-ears,  this 
question  has  greatly  interested  sa\-ants  and  experimenters.  F'or  a  long 
time  the  conditions  necessary  to  the  appearance  of  sugar  in  the  urine 
have  been  known.  Being  indispensable  to  nutrition,  sugar  exists  nor- 
mall}-  in  the  blood  and  tissues.  The  arterial  blood  of  the  dog  contains 
about  I '30  grammes,  and  the  venous  blood  about  90  centigrammes 
per  one  thousand  grammes.  Manufactured  by  the  liver  at  the  expense 
of  its  glycogen,  the  sugar  found  in  the  blood  is  variously  utilised  by  the 
organism  :  one  portion  is  burned  up,  another  is  assimilated  b}-  the 
tissues.  In  health  the  proportion  remains  practicall}-  the  same,  but 
this  ph3-siological  condition  may  be  disturbed,  either  b}'  excessive 
production  of  sugar,  or  by  diminution  in  its  consumption  by  the 
tissues :  in  either  case  h}-perglyc8emia  exists,  the  necessary  precedent 
to  the  appearance  of  sugar  in  the  urine — /.  e.  glycosuria.  The  latter 
condition  occurs  as  soon  as  the  blood  contains  more  than  3  grammes. 


270  CLINICAL    VKTERINARV    MEDICINE    AND    SURCERY. 

of  sugar  per  thousand  ;  in  certain  diabetic  patients  the  proportion  rises 
to  5  or  6  per  thousand.  But  an  animal  whose  urine  contains  sugar  is 
not  necessarily  a  diabetic  subject.  The  temporary  presence  of  sugar  in 
the  urine — transitory  glycosuria — is,  in  fact,  a  symptom  common  to 
various  morbid  states,  to  certain  brain  diseases,  to  auto-intoxications 
and  infections.  What  particularly  characterises  diabetes  is  the 
constancy  or  permanency  of  the  condition.  Temporary  glycosuria  or 
diabetes  can  be  experimentally  produced  by  injuring  the  floor  of  the 
fourth  ventricle  below  the  origin  of  the  pneumogastrics,  by  adminis- 
tration of  various  chemical  substances,  and  by  extirpation  of  the 
pancreas. 

I  shall  not  trouble  you  with  the  theories  of  diabetes.  At  the  present 
time  they  number  almost  thirty.  The  majority  are  based  on  supposed 
disturbance  in  the  glycogenic  function  of  the  liver,  or  on  failure  of 
the  tissues  to  destroy  the  sugar  present  in  the  blood,  due  to  disturbance 
in  assimilation.  M.  Bouchard  regards  diabetes  as  a  disease  due  to 
retarded  nutrition.  It  results  from  nutritive  disturbance  primarily 
characterised  by  failure  or  partial  inability  of  tissue  elements  to  consume 
the  sugar.  MM.  Chauveau  and  Kaufmann  consider  that  variations  in 
the  proportion  of  sugar  contained  in  the  blood  depend  rather  on  hepatic 
production  than  on  disturbance  in  consumption,  and  that  production  of 
sugar  by  the  liver  is  regulated  by  the  nervous  system,  the  pancreas 
exercising  a  kind  of  retarding  function  and  moderating  the  activity  of 
the  hepatic  cells. 

According  to  the  rapidity  of  its  development  diabetes  is  described 
either  as  acute  or  chronic.  Other  "forms  have  been  distinguished, 
depending  on  whether  the  patients  preserve  their  condition  or  undergo 
wasting.  Some  authors  refer  wasting  diabetes  to  lesions  of  the 
pancreas,  but  in  the  dog  it  appears  only  to  be  an  advanced  stage  of  the 
hrst  form  ;  wasting,  in  fact,  is  always  very  marked,  though  lesions  of 
the  pancreas  are  rare.  We  also  recognise  traumatic  diabetes,  most 
frequently  a  result  of  injury  to  the  cranium. 

The  progress  of  diabetes  mellitus  in  the  dog  is  usually  rapid.  Some 
patients  may  live  for  several  months  ;  under  appropriate  treatment  the 
glycosuria  diminishes,  but  improvement  is  only  temporary.  Sooner  or 
later  the  symptoms  become  suddenly  aggravated,  and  most  animals  die 
in  a  state  of  coma. 

Diabetes  in  the  dog  is  very  apt  to  escape  diagnosis.  It  may  be 
suspected  from  the  history,  from  one  or  other  of  the  principal  sym- 
ptoms, such  as  the  excessive  urination,  thirst,  and  appetite;  and  in 
certain  cases  also  from  the  clinical  signs — wasting,  cataract  formation, 


DIAKETES    MELI.ITUS    IN    THK    VO(i.  27 1 

and  enlargement  of  the  liver.  Detection  of  sugar  in  the  urine  confirms 
the  diagnosis,  Fehling's  solution,  prepared  so  that  one  cubic  centi- 
metre is  reduced  by  5  grammes  of  glucose,  forms  an  easy  and  rapid 
means  of  discovering  glycosuria.  You  know  the  method  of  employing 
it  ;  3  or  4  cubic  centimetres  of  the  solution  are  poured  into  a  test-tube 
and  brought  to  boiling-point  (it  should  remain  blue  and  perfectly 
limpid) ;  the  urine  is  afterwards  filtered  and  slowly  added,  being  allowed 
to  run  down  the  side  of  the  tube  so  as  to  form  a  separate  layer  above 
the  solution.  If  it  contains  a  considerable  quantity  of  sugar  the 
surface  of  contact  will  first  show  a  greenish  layer,  which  successively 
becomes  yellow  and  red.  In  performing  quantitative  analysis  it  should 
be  borne  in  mind  that  the  urine  of  diabetic  dogs  contains  a  variable 
proportion  of  uric  acid,  and  of  other  little  known  bodies  which,  like 
sugar,  reduce  Fehling's  solution. 

The  cure  of  saccharine  diabetes  in  the  dog  is  undoubtedly  possible, 
but  up  to  the  present  no  case  has  been  reported.  All  the  patients  have 
died,  the  majority  in  a  very  short  time.  The  cases  said  to  have  been 
cured  really  refer  to  diabetes  insipidus. 

In  slight  or  recent  attacks  treatment  may  prolong  life  for  a  varying 
time.  The  animals  should  not  be  excited.  The  majority  should  not 
be  taken  into  hospital,  or  separated  from  their  owners.  The  food 
should  be  free  of  starchy  and  sugary  materials,  and  is  best  confined 
principally  to  meat,  light  soup  containing  green  vegetables  or  cabbage, 
milk,  and  combinations  of  these  foods.  The  animal  should  be  allowed 
whatever  liquid  it  requires.  Exercise  must  be  given,  but  fatigue 
avoided. 

Medical  treatment  comprises  alkalies,  particularly  bicarbonate  of 
soda,  and  when  wasting  is  marked,  preparations  of  arsenic  or  ^•alerian. 

It  must  also  be  remembered  that  diabetic  patients  are  particularly 
predisposed  to  infections.  Only  urgent  operations  should  be  under- 
taken and  the  strictest  aseptic  precautions  observed.  In  the  comatose 
stage  drastic  purgatives,  large  doses  of  bicarbonate  of  soda,  and  hypo- 
dermic injections  of  ether  and  caffeine  probably  offer  the  greatest  chance 
of  improvement. 


XXXVII.— EXOPHTHALMIC    GOITRE. 

At  the  beginning  of  the  present  week  I  specially  retained  in  hospital 
a  horse  showing  certain  curious  symptoms,  to  which  I  drew  your  parti- 
cular attention.  The  animal  was  about  fifteen  years  old,  and  had  been 
its  present  owner's  possession  for  five  months.  Until  the  last  few  days 
it  had  enjoyed  good  health  and  done  regular  work.  We  were  informed 
that  it  then  left  a  part  of  its  food,  that  the  faeces  became  small  in 
quantity  and  hard,  and  that  the  animal  seemed  less  active  at  work. 

In  this  patient  we  immediately  noted  a  two-lobed  swelling  formed 
by  enlargement  of  the  th3Toid  gland,  and  situated  opposite  the  origin 
of  the  trachea  :  the  left  lobe  was  larger  than  the  right.  Both  lobes 
were  soft,  elastic,  resistent,  slightl}-  fluctuating,  moveable  under  the 
skin,  and  somewhat  adherent  to  the  deeper  seated  tissues.  The  mouth 
was  dry,  but  there  was  no  dental  disturbance.  Palpation  of  the 
abdomen  was  not  painful,  and  no  signs  of  obstruction  of  the  intestine 
could  be  detected. 

There  was  no  tachycardia  (rapid  action  of  the  heart),  no  palpitation, 
no  intermittenc}- ;  in  fact,  no  other  trouble.  The  respiratory  moAC- 
ments  were  not  accelerated.  The  temperature  hardly  registered  38'^'^ 
C.  (ioi'3°  F.).  Having  noted  these  points  you  saw  that  I  examined 
the  eyes  in  order  to  judge  of  their  size  and  prominence.  In  the  letter 
sent  me  "slightly  pronounced  abnormal  prominence  of  both  eyes" 
was  mentioned.  In  point  of  fact  there  was  no  \isible  exophthalmia. 
Although  the  animal  showed  goitre  and  a  cardiac  murmur  its  want  of 
appetite  was  due  entirely  to  enteritis.  It  was  certainly  not  suffering 
from  exophthalmic  goitre.  Ne\ertheless,  since  I  have  brought  the 
question  before  you,  I  shall  not  allow  it  to  pass  without  describing  to 
you  in  what  exophthalmic  goitre  consists. 

In  human  medicine,  for  rather  more  than  half  a  century,  there  has 
been  described  under  the  titles  of  exophthalmic  goitre.  Graves'  disease, 
and  Basedow's  disease  a  morbid  condition,  the  exact  nature  of  which 
is  still  little  understood,  but  which  is  clearU-  distinguished    h\  three 


EXOPHTHALMIC    GOITRE.  273 

principal    symptoms — palpitation    of    the    heart,    goitre,    and   exoph- 
thalmia. 

This  disease  had  hardly  been  discovered  when  its  essential 
characteristics  were  identified  and  well  described  in  England  by 
Graves,  and  in  Germany  by  Basedow.  Trousseau  gives  a  masterly 
sketch  in  the  second  volume  of  his  Cliniques  Medicales  de  VHotel-Dieu. 
Since  that  time  it  has  been  the  subject,  both  in  France  and  abroad,  of 
many  observations  and  interesting  researches. 

The  first  cases  of  exophthalmic  goitre  in  animals  were  only 
announced  in  1888.  At  this  date  the  Russian  veterinary  surgeon 
Jewsejenko  described  two,  one  in  a  mare  and  the  other  in  a  bitch. 

The  first  was  that  of  a  four-year-old  thoroughbred  mare  which, 
when  fatigued  after  racing,  exhibited  grave  disturbance,  at  first  referred 
to  brain  disease.  For  a  fortnight  she  showed  weakness,  dulness,  loss 
of  appetite,  excessive  thirst,  slight  acceleration  of  breathing,  rapid 
action  of  the  heart,  palpitation,  strong  pulse,  hypertrophy  of  the 
thyroid  gland,  injection  of  the  conjunctivae,  and  slight  infiltration  of 
the  eyelids.  Suddenly,  on  the  sixth  day,  exophthalmia  became  very 
marked.  The  globes  of  both  eyes  were  fixed,  and  the  eyelids  could  not 
be  closed.  The  lobes  of  the  thyroid  gland  showed  pulsation,  and 
continued  to  increase  in  size.  The  temperature  rose  to  40°  C.  (104°  F.). 
The  patient  died  of  exhaustion  at  the  end  of  a  month.  No  post-mortem 
examination  was  made. 

The  second  case  was  that  of  a  seven-year-old  bitch,  whicfi  was 
reported  as  having  once  suffered  from  an  epileptiform  seizure  while 
being  exercised  in  hot  weather.  Psychic  disturbance,  agoraphobia 
(fear  of  open  spaces),  and  symptoms  of  great  irritability  persisted,  and 
were  later  succeeded  by  rapid  action  of  the  heart,  palpitation,  hyper- 
trophy of  the  thyroid  gland,  and  finally  exophthalmia.  The  globes  of 
the  eyes  projected  prominently,  preventing  closure  of  the  eyelids.  An 
ulcer  developed  on  the  cornea  of  the  left  eye,  and  afterwards  perforated 
the  membrane. 

After  the  appearance  of  the  above,  four  new  cases  of  exophthalmic 
goitre  were  published — two  in  the  horse,  one  in  the  cow,  and  one  in  the 
dog.* 

This  is  the  only  information  we  possess  regarding  this  singular 
disease.  It  is  certainly  rare  in  animals,  though  the  paucity  of  reported 
cases  is  certainly  in  some  degree  due  to  the  attention  of  veterinary 
surgeons  not  having  been  called  to  it. 

'■'  A  second  case  of  exophthalmic  goitre  in  the  cow  was  published  in  1898  by  Gehrig  in 
the  Deutsche  Thieriirstliche  Wochenschrift ;  and  a  third  in  the  horse,  in  1899,  by  Ries  in  the 
Recueil  de  Medecine  Veterinaire. 

S 


274  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

In  man  the  disease  is  usually  announced  by  palpitation,  which 
occurs  suddenly  after  a  physical  or  moral  shock,  accident,  violent 
emotion,  fright,  or  exhausting  work,  though  the  onset  may  be  insidious, 
and  aggravation  gradual.  The  heart-beats  are  sudden,  and  so  violent 
as  to  be  visible  over  a  large  surface  of  the  chest  or  even  over  the 
whole  body.  On  auscultation  the  normal  heart-sounds  are  magni- 
fied, and  have  a  metallic  ring,  or  are  accompanied  by  murmurs, 
the  position  and  intensity  of  which  vary,  but  are  most  commonl}^  soft 
and  systolic.  The  radial  pulse  is  generally  feeble,  sometimes  arhyth- 
mic ;  in  certain  cases  it  cannot  be  counted  owing  to  its  frequency  ; 
on  the  other  hand,  it  may  also  preserve  its  normal  character  for  a  long 
time.  The  carotids  beat  strongly,  showing  bounding  movements, 
resembling  that  "  dancing  of  the  arteries  "  seen  in  certain  heart  dis- 
eases. Auscultation  with  the  stethoscope  sometimes  detects  soft  or 
rough  murmurs.  The  superficial  veins,  those  of  the  limbs,  and  the 
jugulars  more  especially  are  large  and  distended.  Both  jugulars  show 
strong  pulsation. 

Hypertrophy  of  the  thyroid  gland  is  sometimes  uniform,  extending 
equally  to  both  lobes  ;  sometimes  it  is  more  pronounced  in  one  than  in 
the  other.  Goitre  seldom  appears  rapidly.  In  most  cases  the  gland 
gradually  increases  in  size,  remaining  somewhat  elastic,  soft,  and 
moveable  under  the  skin.  It  is  very  vascular,  and  on  auscultation 
sometimes  reveals  an  arterial  murmur  isochronous  with  the  beating  of 
the  heart.     In  time  it  may  undergo  hardening. 

Exophthalmia — that  is,  excessive  prominence  of  the  globes  of  the 
eyes — is  usually  equally  marked  in  both  eyes.  It  may  even  develop 
sufficiently  to  prevent  the  eyelids  closing,  or  to  threaten  displacement 
of  the  eyes ;  this  accident  has  indeed  been  seen.  In  other  cases  dis- 
placement may  be  very  slight,  or  fail  to  occur.  In  addition  to  undue 
prominence  of  the  eye  rupture  of  the  cornea  is  sometimes  seen  ;  the 
animal's  gaze  becomes  fixed,  tears  escape  over  the  face,  and  the 
sclerotic  is  hypersemic.  The  pupil  is  usually  normal ;  sometimes,  how- 
ever, it  is  dilated  or  contracted.  In  most  patients  the  chambers  of  the 
eye  remain  intact  and  vision  is  unaffected,  but  some  show  dilatation  of 
the  retinal  vessels,  myopia,  or  presbyopia. 

To  these  three  symptoms  must  be  added  trembling,  an  almost 
always  constant  sign,  which  is  no  less  important  than  the  preceding. 
This  trembling  is  sometimes  limited  to  the  limbs,  in  the  upper  parts  of 
which  it  is  particularly  marked.  Sometimes  it  is  general,  all  the 
muscles  showing  fibrillary  movements. 

Various  secondary  disturbances  are  seen.  Appetite  is  lost ;  diges- 
tion is  bad  ;  attacks  of  diarrhoea  occur ;  bodily  condition  and  strength 


EXOPHTHALMIC   GOITRE.  275 

diminish.  In  some  patients  there  may  be  cough,  oppression,  and 
anxiety;  in  others  the  skin  is  warm,  dry,  and  affected  with  obstinate 
pruritus  ;  abscesses  may  develop  in  the  subcutaneous  connective  tissue 
in  different  regions.  Other  troubles  of  cerebro-medullar  origin  may 
also  be  present :  at  first  there  is  insomnia,  in  consequence  of  over- 
excitement  of  the  brain  ;  at  a  later  stage  there  may  be  change  in 
character  and  unusual  irritability  or  depression.  Polyuria,  albuminuria, 
and  glycosuria  are  frequent. 

Basedow's  disease  is  not  invariably  characterised  by  all  the  appear- 
ances I  have  just  mentioned.  In  some  instances  even  the  triad  of  S)'m- 
ptoms  which  are  usually  so  suggestive  fail  to  appear.  In  the  obscure  forms 
enlargement  of  the  thyroid  and  prominence  of  the  globes  of  the  eyes 
are  little  pronounced,  or  absent ;  in  one  variety  goitre  is  little  marked, 
and  abnormal  projection  of  the  eyes  altogether  wanting ;  in  another 
there  is  marked  hypertrophy  of  the  thyroids,  and  exophthalmia  is 
scarcely  noticeable ;  in  others  again  only  tachycardia  and  trembling 
movements  are  seen.  Cardiac  disturbance  is  constant ;  it  constitutes 
the  first  and  predominant  symptom  of  the  disease. 

In  by  far  the  greatest  number  of  cases  exophthalmic  goitre  is  a 
chronic  affection.  Its  development  is  slow,  interrupted  by  paroxysms 
in  which  palpitation  and  hypertrophy  of  the  thyroid  are  particularly 
well  marked.  At  the  very  outset  development  may  be  acute ;  the 
disease  may  appear  suddenly,  and  almost  immediately  be  accompanied 
by  palpitation,  hypertrophy  of  the  thyroid,  and  exophthalmia  ;  but  its 
after  progress  is  slow.     Rapidly  progressive  cases  are  rare. 

After  continuing  for  a  period  varying  between  a  few  months  and 
ten,  twelve,  or  fifteen  years,  the  disease  may  terminate  in  recovery,  or 
prove  fatal.  Death  sometimes  results  from  cerebral  haemorrhage, 
sometimes  from  exhaustion,  usually  preceded  by  intractable  diarrhoea, 
or  from  intercurrent  infectious  disease. 

The  post-Jiwrteni  examination  of  persons  who  have  died  of  exoph- 
thalmic goitre  does  not  always  show  lesions  in  the  more  important 
organs  sufficiently  explaining  death.  The  heart  is  normal,  dilated, 
or  hypertrophied  ;  in  the  last  case  hypertrophy  may  either  be  total, 
or  limited  to  the  left  ventricle.  The  valves  are  normal  or  thickened  ; 
sometimes  the  calibre  of  the  carotids  is  increased. 

The  thyroid  arteries  are  dilated  and  sinuous.  The  thyroid  gland 
is  enveloped  in  a  layer  of  connective  tissue,  penetrated  in  all  directions 
by  large  venous  channels ;  its  tissue  varies  in  consistence  and  colour, 
but  is  usually  of  a  deep  tint,  very  vascular,  and  in  exceptional  cases 
fibrous  or  sclerosed. 


276  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

Even  the  ophthalmic  artery  is  often  dilated.  The  membranes  of 
the  eye,  particularly  the  choroid  and  retina,  are  hypersemic  ;  the  retinal 
arteries  and  veins  have  been  found  dilated,  the  retina  infiltrated  with 
blood  and  pigmented,  the  choroid  strongly  injected. 

Other  lesions  may  exist  in  the  principal  viscera.  The  stomach, 
intestine,  liver,  spleen,  kidneys,  and  brain  are  sometimes  hyperasmic. 
In  many  cases  hypertrophic  cirrhosis  has  been  noted  ;  in  others  renal 
lesions,  similar  to  those  of  Bright's  disease.  Such  lesions,  however, 
are  of  secondary  importance,  for  in  most  cases  the  viscera  show 
nothing  special. 

Exophthalmic  goitre  is  characterised  by  very  special  features,  and 
forms  a  well-defined  condition.     But  what  is  its  nature  ? 

One  theory  regards  it  as  a  disease  of  nutrition,  a  cachexia.  In  the 
obstinate  and  persistent  form,  in  that  which  kills,  the  blood  at  length 
undergoes  change,  nutrition  languishes,  anaemia  sets  in,  and  becomes 
more  or  less  rapidly  accentuated.  In  the  case  I  related  nutrition  was 
evidently  affected,  wasting  and  visible  weakness  were  extreme  ;  oedema 
had  occurred  in  the  lower  parts  of  the  body,  diarrhoea  was  permanent, 
and  finally,  numerous  purulent  centres  developed  in  the  subcutaneous 
connective  tissue  of  different  regions.  In  this  form  death  generally 
occurs  from  progress  of  the  cachexia,  though  the  nutritive  change  is 
only  an  effect  and  not  a  cause  of  the  disease.  It  is  not  seen  in  trifling 
cases  which  develop  slowly,  remain  stationary,  or  diminish.  The 
disease  itself  is  therefore  not  a  cachexia. 

Many  persons  still  regard  the  disease  as  of  nervous  origin,  and 
consider  it  principally  due  to  causes  acting  on  the  brain,  such  as  severe 
nervous  excitement,  depressing  circumstances,  or  violent  emotion. 
Physiology,  they  say,  has  shown  that  local  congestions  may  be  caused 
by  purely  nervous  impulses.  The  congestive  phenomena  occurring  in 
the  thyroid  gland  and  in  the  eyes  are  said  to  result  from  "  nervous 
paroxysms,"  which,  through  the  medium  of  the  sympathetic,  provoke 
disturbance  of  circulation.  They  thus  claim  to  prove  that  the  three 
main  S3'mptoms  result  from  one  cause,  that  is  to  say,  from  primary 
disturbance  in  the  brain.  They  describe  the  disease  as  a  "  cerebro- 
medullary  disease,  a  congestive  neurosis,  w^iich  progresses  by 
paroxysms." 

At  the  present  day  the  tendency  is  to  regard  it  as  an  auto-intoxica- 
tion, produced  by  excessive  activity  or  functional  disturbance  of  the 
thyroid  gland  itself.  Certain  symptoms,  or  even  the  entire  group  of 
symptoms,  peculiar  to  exophthalmic  goitre  can  easily  be  produced  in 
animals    b}-    injecting    certain    toxic    substances.     M.    Bouchard    has 


EXOPHTHALMIC    GOITRE.  277 

shown,  for  example,  that  exophthalmia  may  be  determined  by  injecting 
injurious  substances  excreted  by  the  kidney.  MM.  Ballet  and  Enriquez 
exhibited  at  the  Societe  Medicale  des  Hopitaux  a  dog  in  which  the 
symptoms  of  exophthalmic  goitre  had  been  produced  by  long-continued 
feeding  on  extract  of  thyroid  gland.  Toxic  principles  poured  into,  or 
retained  in  the  blood  in  excessive  quantity  act  on  the  nervous  centres, 
and  thus  excite  the  complex  disturbance  recognised  as  exophthalmic 
goitre. 

When  clearly  marked  and  accompanied  by  the  essential  symptoms 
exophthalmic  goitre  cannot  be  mistaken  for  any  other  disease.  No 
other  produces  excessive  prominence  of  the  eyes,  enlargement  of  the 
thyroid  gland,  palpitation,  and  trembling  movements.  Nevertheless 
in  ill-defined  or  incomplete  cases  mistakes  are  easy.  Even  in  man  the 
disease  has  sometimes  been  mistaken  for  slowly  developing  typhoid 
fever,  or  for  tuberculosis.  Until  recently  its  occurrence  in  animals 
was  not  recognised  ;  it  formed  one  of  that  group  of  unnamed  diseases 
the  nature  of  which  can  only  be  discovered  by  clinical  and  anatomico- 
pathological  investigations.  When  recent  it  may  be  mistaken  for  true 
palpitation,  for  "  diaphragmatic  chorea,"  or  for  heart  disease.  But 
simple  cardiac  palpitation  and  spasm  of  the  diaphragm  are  usually 
temporary  affections ;  and  even  when  they  persist  for  a  certain  time 
they  at  least  diminish  in  intensity  after  a  few  days,  while  the  other 
symptoms  of  exophthalmic  goitre  fail  to  appear.  Similarly  in  true 
heart  disease  there  is  neither  enlargement  of  the  thyroid,  protrusion 
of  the  eyeballs,  nor  trembling. 

The  prognosis  is  grave.  In  most  cases,  as  I  have  said,  the  disease 
steadily  progresses,  and  leads  to  death  after  a  varying  period  ;  in  others 
it  may  become  arrested.  Sometimes  it  disappears  almost  completely; 
sometimes  cure  is  incomplete,  enlargement  of  the  thyroid  and  ex- 
ophthalmia  persisting  in  a  modified  degree. 

Treatment  includes  administration  of  drugs  and  surgical  interven- 
tion. Patients  should  receive  nourishing  food,  should  live  in  the  open 
air,  and  be  rested  or  very  moderately  exercised.  Electricity,  especially 
in  the  form  of  the  continuous  current,  has  been  recommended,  the 
terminals  being  applied  on  either  side  of  the  heart.  Hydrotherapy 
also  has  its  supporters.  Medication  is  chiefly  symptomatic,  and  com- 
prises the  administration  of  iodine,  iodides,  bromides,  digitalis,  valerian, 
and  arsenic.  A  new  method  of  treatment,  which  has  been  attended 
with  improvement,  and  even  with  cure  in  some  unlooked-for  cases, 
■consists  in  administering  thyroid  extract,  or  tabellae  of  iodothyrin. 

Encouraging  results   have    also  followed    surgical  intervention  in 


278  CLINICAL   VETERINARY    MEDICINE    AND    SURGERY. 

connection  with  the  thyroid  gland  and  resection  of  the  cervical  sym- 
pathetic. 

I  have  made  this  short  incursion  into  the  domain  of  the  other 
medicine  in  order  to  draw  your  attention  to  a  disease  which  has 
scarcely  been  observed  in  animals,  cases  of  which,  however,  if  closely 
studied  and  carefully  reported,  would  be  of  great  interest  from  the 
point  of  view  of  comparative  pathology. 


XXXVIII.— ECZEMA    IN    THE    DOG. 

Of  all  domestic  animals  the  dog  most  frequently  suffers  from  skin 
diseases.  Dogs  so  affected  are  received  into  hospital  at' all  times  of 
the  year,  and  a  day  never  passes  without  your  seeing  a  certain  number 
in  the  clinique. 

The  study  of  these  diseases  has  been  greatly  neglected.  Until  a 
comparatively  recent  time,  although  the  microscope  had  become  a 
common  instrument,  the  number  of  practitioners  who  used  it  to  con- 
firm their  diagnosis  of  cutaneous  disease  in  the  dog  was  distinctly 
small.  The  progress  made  in  the  field  of  human  dermatology  induced 
M.  Megnin  and  some  other  veterinary  surgeons  to  make  a  special  study 
of  diseases  of  the  skin  in  domestic  animals.  At  the  present  day  the 
majority  of  such  diseases  in  the  dog  are  well  recognised,  and  diagnosis 
is  usually  easy. 

Eczema,  which  was  first  separated  from  the  various  forms  of  mange, 
then  from  the  dermatomycoses  and  the  several  varieties  of  dermatitis, 
still  comprises  a  number  of  diseases,  dissimilar  as  regards  their  appear- 
ance and  course,  but  which  will  undoubtedly  be  differentiated  later. 
At  the  present  moment  the  word  eczema  cannot  well  be  applied  to  a 
simple  morbid  condition,  but  refers  to  a  group  of  dermatoses,  of  acute 
or  chronic  course,  differing  as  to  symptoms  and  lesions,  usually  re- 
bellious to  treatment,  apt  to  return,  and  usually  seen  in  combination 
with  a  special  diathesic  condition. 

Clinically,  eczema  appears  as  an  eruptive  dermatitis,  commonest  in 
animals  with  the  above-mentioned  predisposition,  directly  produced  by 
external  or  internal  causes,  sustained  by  pruritus  and  the  consequent 
scratching  or  rubbing,  variable  in  character,  development,  and  gravity. 
According  to  the  degree  of  intensity  it  has  been  divided  into  acute  and 
chronic  forms.  In  ma«y  cases  the  former  is  only  the  first  stage  of  a 
process  which  afterwards  develops  slowdy,  producing  obstinate  and 
often  permanent  lesions. 

It   affects   animals  of  all  breeds  and  ages,  seems   almost    equally 


28o  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

frequent  in  both  sexes,  but  is  particularly  common  during  the  second 
half  of  life.  Apart  from  the  eruption  of  distemper,  young  dogs  seldom 
show  more  than  ephemeral  vesicular  outbreaks  quite  different  from  the 
ec2ema  of  aged  animals.  The  disease  does  not  attack  all  regions  with 
equal  frequence,  appearing  to  have  a  preference  for  the  upper  parts  of 
the  body  like  the  head,  neck,  back,  loins,  and  croup,  and  for  the  point 
of  the  elbow,  groin,  scrotum,  tail,  and  interdigital  spaces.  When 
chronic  and  of  old  standing  it  may  be  more  or  less  generalised.  Then 
it  is  usually  exceedingly  rebellious  about  the  back,  elbows,  hocks,  in 
the  ear,  and  at  the  extremity  of  the  tail. 

At  the  beginning  of  any  summary  of  the  conditions  favourable  to 
the  outbreak  of  eczema  must  be  mentioned  that  important  idea  that 
eczematous  eruptions  are  often  subordinate  to  a  constitutional  condi- 
tion or  diathesis ;  in  the  case  of  young  dogs  to  a  lymphatic  tempera- 
ment, in  adults  and  the  aged  to  a  gouty  diathesis,  to  obesity,  and 
sometimes  to  diabetes.  This  general  condition  largely  determines  the 
occurrence  of  the  disease,  and  demands  special  treatment :  in  certain 
subjects  it  produces  disturbance  in  the  functions  of  the  stomach, 
intestine,  and  liver,  mal-assimilation  accompanied  by  auto-intoxica- 
tion ;  conditions  which  favour  the  development  of  eczema,  render  it 
liable  to  appear  under  the  influence  of  trifling  causes,  and  may  even 
constitute  the  primary  factor.  Many  animals  with  rebellious  eczema 
are  also  affected  with  chronic  bronchitis,  emphysema,  or  asthma  ;  and 
eczematous  attacks  not  infrequently  alternate  with  certain  affections  of 
the  digestive  or  respiratory  apparatus.  Feeding  also  plays  a  part  in 
the  development  of  eczema  :  depending  on  the  conditions  under  which 
the  animal  lives,  attacks  may  be  produced  either  by  an  exclusively 
vegetable  or  exclusively  meat  diet. 

Eczematous  eruptions  are  generally  preceded  by  cutaneous  irrita- 
tion of  variable  character  and  intensity.  They  may  be  caused  by 
clipping,  repeated  rubbing,  pressure  of  the  collar,  the  action  of  alka- 
line or  acid  solutions,  or  by  external  parasites  affecting  the  parts  which 
most  commonly  become  diseased.  Want  of  cleanliness  and  accumula- 
tion of  dust  or  sebaceous  secretions  on  the  surface  may  readily  bring 
about  outbreaks.  In  certain  cases,  on  the  other  hand,  they  may  result 
from  excessive  use  of  soap  and  warm  or  cold  water.  During  the 
summer  they  are  not  infrequently  produced  by  the  action  of  the  sun's 
rays  on  the  skin. 

The  part  played  by  the  circulatory  and  nervous  apparatus  in  the 
genesis  of  eczema  is  still  obscure.  In  dogs  the  symmetrical,  slowly 
developing  eruptions,  apparently  of  nervous  origin,  are  rare. 


ECZEMA    IN    THE    DOG.  28 1 

Heredity  exercises  an  unquestionable  influence.  It  depends  on  the 
transmission  of  a  tendency  to  changes  in  the  bodily  fluids,  or  to  general 
nutritive  disturbance. 

Bacteriology  had  scarcely  been  raised  to  the  rank  of  a  science 
before  at-tempts  were  made  to  found  a  parasitic  theory  of  eczema. 
Eczematous  patches  exhibit  a  complex  flora  of  micrococci  and 
bacteria,  whose  rule  in  the  pathogen}-  of  outbreaks  is  still  undeter- 
mined. In  point  of  fact,  organisms  may  be  found  as  abundantl}-,  and 
in  as  great  variety,  on  the  healthy  skin  of  neighbouring  parts.  Never- 
theless the  microbes  which  multiply  on  eczematous  spots  are  not 
without  influence  on  the  course  and  changes  of  the  disease.  They 
aggravate  acute  eczema,  and  parth'  contribute  to  the  obstinacy  of 
chronic  forms.  Nowadays  the  tendency  appears  to  be  in  favour  of 
admitting  that  human  vesicular  eczema  results  from  the  action  of 
various  cocci  which  occur  massed  in  twos,  fours,  or  larger  numbers, 
and  which  either  occupy  the  intercellular  spaces,  or  are  included 
within  the  cells  forming  the  vesicle  ;  to  these  Unna  has  given  the  name 
of  morococci.  In  impetigo,  a  disease  now  regarded  as  contagious  and 
inoculable,  pyogenic  microbes,  especially  the  Staphylococcus  pyogenes 
alhus  and  aureus,  appear  to  be  the  true  agents  of  transmission. 
Whether  it  succeed  to  certain  suppurating  skin  lesions  or  originate  in 
trifling  superficial  solutions  of  continuity  in  the  skin,  this  form  essen- 
tially consists  in  infection  of  the  papillary  layer,  and  is  characterised  by 
pustulation,  followed  by  more  abundant  secretion  than  that  of- ordinary 
eczema.  But  further  research  is  necessary  to  determine  the  part 
played  by  microbes  in  the  pathogeny  of  eczema. 

The  chief  causes  of  eczematous  disease  in  the  dog  are  cutaneous 
irritation,  disturbed  nutrition,  improper  feeding,  and  abnormal  condi- 
tions of  life.  ^Etiologicall}'  these  skin  diseases  may  be  divided  into 
two  groups,  under  the  titles  of  essential  and  symptomatic  eczema. 
Essential  eczema  is  directly  induced  by  external  irritation  of  any 
given  portion  of  the  skin.  In  dogs  with  fine  skin  it  may  be  caused  by 
mechanical,  thermic,  or  chemical  agencies  ;  by  rubbing  or  repeated 
pressure  ;  by  solar  irritation  ;  and  by  the  action  on  the  skin  of  an}- 
of  a  large  number  of  topical  irritants.  It  soon  disappears,  w-ithout 
spreading.  It  appears  to  have  no  hold  on  the  organism,  and  does  not 
return  unless  the  causes  which  have  produced  it  are  repeated. 

The  pathogeny  of  symptomatic  eczema  is  dominated  by  some 
internal  causes,  either  of  constitutional,  alimentary,  or  nervous  origin. 
Various  changes  in  the  body  fluids  resulting  from  previous  morbid 
conditions,  or  from  mal-assimilation,  may  produce  it.  Sometimes 
these  internal  influences  are  alone  the  cause ;  sometimes,  while  giving 


282  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

rise  to  an  excessively  irritable  condition  of  the  skin,  they  are  seconded 
by  direct  irritation,  such  as  pressure,  friction,  or  the  action  of  cold  or 
heat. 

What  are  the  clinical  anatomical  characters  of  acute  eczema  ? 

The  eruption  appears  in  the  form  of  little  red  spots,  varying  in  size 
between  that  of  a  lentil  and  a  pea,  very  closely  massed  together,  and 
sometimes  almost  confluent.  These  hyperaemic  patches  increase  in 
size,  their  centres  become  thickened  and  prominent,  and  fresh  patches 
form  ;  this  stage  constitutes  papular  eczema.  When  all  parts  of  the 
diseased  surface  are  inflamed  and  red  the  eczema  is  termed  erythe- 
matous. In  this  case  there  is  severe  pruritus,  which  provokes  incessant 
scratching.  In  some  rare  cases  the  papules  disappear,  the  epidermis 
desquamates,  and  the  congestion  of  the  skin  vanishes ;  but  almost 
always  a  little  drop  of  serous  fluid  collects  above  the  papule,  which  is 
then  transformed  into  a  vesicle  ;  the  eczema  has  become  vesicular. 
Almost  as  soon  as  formed  the  phlyctenae  are  ruptured  in  consequence 
of  scratching  ;  resorption  of  the  contents  of  vesicles  is  quite  exceptional. 
The  diseased  surface  is  then  more  or  less  denuded  of  hair,  the  epidermis 
destroyed,  and  the  papillary  layer  inflamed  ;  the  exuded  liquid  is  first 
serous,  afterwards  purulent ;  it  soon  forms  a  viscous  layer  which  exhales 
an  offensive  smell :  at  this  stage  the  eczema  is  known  as  moist  or 
secreting.  Common  eczema  rubrum  is  only  a  variety  of  moist  eczema 
characterised  by  marked  redness  of  the  skin,  which  is  deprived  of  its 
epidermal  covering. 

At  this  stage,  which  persists  for  some  days,  animals  are  usuall}' 
brought  for  advice.  Over  the  eczematous  patch  the  hair  is  glued 
together  by  transuded  liquid  ;  in  long-haired  dogs  it  forms  a  felted 
mass  covered  with  a  pseudo-membranous  exudate  ;  the  papillary  layer 
is  inflamed,  swollen,  red,  finely  granular,  and  extremely  sensitive.  The 
least  touch  produces  pain  ;  quiet  animals  avoid  examination,  others 
may  threaten  to  bite.  On  carefully  examining  the  skin  around  the 
discharging  patch,  vesicles  of  recent  formation  may  be  seen.  By  for- 
mation of  such  vesicles  in  concentric  zones  the  eczema  spreads  from 
the  spot  where  it  originated  to  adjacent  parts.  Having  arrived  at  full 
development  it  may  persist  with  these  characters  for  three  to  six  days, 
sometimes  longer,  after  which  the  stages  of  recovery  commence.  But 
this  regular  course  is  not  infrequently  disturbed  by  various  accidents 
which  impart  a  special  character  to  the  cutaneous  lesions.  When 
inflammation  is  aggravated  by  rubbing,  it  may  affect  the  deeper  layers 
of  the  skin,  which  granulate,  crack,  or  become  wrinkled. 

In  ordinary  cases  the  liquid  transuded  by  the  papillary  layer  becomes 


ECZEMA    IN    THE    DOG.  283 

converted  into  greyish  or  yellowish  crusts,  sometimes  tinted  brown  by 
admixture  of  extravasated  blood  ;  the  eczema  has  become  crustaceous. 
In  some  animals  the  superficial  layer  of  the  skin  is  infiltrated  with 
pyogenic  microbes  and  covered  with  yellowish  crusts,  beneath  which 
suppuration  continues ;  these  crusts  presently  become  lifted  and  cracked 
across,  allowing  the  pus  to  exude  ;  the  eczema  is  then  known  as  impeti- 
ginous. Sometimes  suppuration  is  scarcely  apparent ;  the  crusts  at 
first  formed  remain  adherent,  then  dry  up  and  fall  away.  In  either 
case,  once  the  crusts  are  shed  the  skin  is  seen  to  be  still  slightly 
swollen,  reddish,  and  the  seat  of  more  or  less  abundant  desquamation  ; 
the  eczema  has  become  squamous.  Finally,  if  recovery  occur,  the 
swelling,  hypersemia,  and  exfoliation  disappear.  In  a  short  time  the 
dermis  resumes  its  normal  condition,  and  hair  commences  to  grow. 

We  may  summarise  the  successive  stages  of  acute  eczema  as 
follows  : — Redness  and  swelling  of  the  skin  ;  papules  ;  vesicles,  which 
may  or  may  not  become  transformed  into  pustules  and  rupture ;  dis- 
charge ;  crusts  ;  desquamation.  Development  always  follows  a  certain 
order,  but  in  reality  no  skin  disease  offers  more  diversified  appearances  ; 
a  series  of  eruptive  attacks  may  occur  at  very  short  intervals  ;  sometimes 
the  symptoms  characteristic  of  these  different  stages  are  all  present  in 
one  patient,  and  even  confined  within  a  very  narrow  area ;  a  dis- 
charging patch  may  be  surrounded  by  vesicles,  papules,  or  red  areas ; 
the  eruption  may  be  localised,  disseminated,  or  almost  generalised, 
while  secondary  lesions  not  infrequently  accompany  those  just  men- 
tioned. The  acute  pruritus  seen  during  eruption  causes  continual 
rubbing  or  scratching,  sometimes  leading  to  severe  cutaneous  inflam- 
mation and  more  or  less  extensive  destruction  of  the  papillary  layer. 
If  exposed  and  excoriated,  the  lymphatic  vessels  opening  on  the 
diseased  surfaces,  and  the  groups  of  lymphatic  glands  in  which  they 
terminate,  may  become  inflamed. 

In  generalised  eczema — and  by  this  term  I  wish  you  to  understand 
not  an  eruption  simultaneously  affecting  the  entire  skin,  but  the 
existence  of  disseminated,  isolated,  or  partially  confluent  centres,  vary- 
ing in  age  and  characters,  on  the  body,  head,  and  limbs, — in  this  form, 
I  say,  one  may  see  febrile  symptoms  and  loss  of  appetite,  the  exacerba- 
tions coinciding  with  fresh  extensions,  and  finally  complications  due 
to  visceral  lesions. 

An  erythematous  affection  occurs,  which  in  France  is  known  under 
the  name  of  rouge  (red),  but  which  has  no  connection  with  sarcoptic  or 
follicular  mange.  It  is,  in  fact,  a  form  of  eczema.  The  eruption  affects 
parts  where  the  skin  is  fine  and  almost  bare,  or  where  hair  is  scanty, 
especially  the  elbow,  groin,  and  inner  surface  of  the  upper  parts  of  the 


284  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

limbs,  sometimes  even  the  lower  surfaces  of  the  thorax  and  abdomen. 
It  is  principally  seen  in  young  or  adult  animals,  but  the  suggestion  that 
it  specially  affects  certain  breeds  is  erroneous ;  all  are  subject  to  it. 

It  is  characterised  by  reddening  of  the  skin  and  acute  itching  ; 
where  the  hair  is  white  the  skin  shows  a  reddish  tint.  On  the  inflamed 
skin  little  vesicles  develop,  which  rupture,  and  are  sometimes  followed 
by  superficial  ulceration  and  trifling  discharge.  In  the  more  obstinate 
cases  a  series  of  vesicular  eruptions  may  occur  ;  the  layers  of  the  skin 
become  swollen  and  covered  with  a  layer  of  thickened  epidermis  marked 
by  crusts  and  folds.  Cases  occur  where  this  erythema,  though  at  first 
localised,  gradually  extends  along  the  sides  of  the  thorax  and  abdomen 
behind,  along  the  perinaeum  as  far  as  the  anus  ;  anteriorly  along  the 
lower  surface  of  the  neck  as  high  as  the  head.  In  most  patients  the 
inflammation  is  particularly  acute  in  the  folds  of  skin  around  the  elbow 
and  groin,  where  the  two  surfaces  of  skin  in  contact  become  excoriated, 
and  sometimes  discharge  rather  abundantly. 

Apart  from  the  common  form  of  eczema,  accidental  cases  occur  of 
what  Unna  described  in  man  ten  years  ago  as  seborrhoeic  eczema, 
characterised  by  a  special  inflammatory  condition  of  the  skin,  epi- 
dermis, and  sebaceous  and  sudoriparous  glands,  and  by  depilation  of 
regular,  sharply  defined  surfaces  which  gradually  extend,  and  some- 
times heal  at  the  centre.  This  seborrhoea  is  dry,  squamous,  or  crus- 
taceous.  As  a  rule  the  orifices  of  the  sebaceous  glands  are  obliterated 
in  consequence  of  excessive  growth  of  the  epidermis,  the  glands  them- 
selves being  hypertrophied  and  the  capillary  follicles  atrophied. 

Attacks  of  eczema  have,  as  I  said,  a  well-marked  predilection  for 
certain  regions,  though  they  may  be  found  everywhere  ;  no  portion  of 
the  skin  is  exempt.  Some  present  special  characters  due  to  their 
position,  such  as  eruptions  on  the  eyelids,  ear,  scrotum,  and  inter- 
digital  skin.  Eczema  of  the  eyelids  causes  marked  swelling,  depilation, 
acute  itching,  and  conjunctivitis,  with  rather  abundant  discharge, 
which  sometimes  glues  together  the  lids.  That  of  the  ear  produces  an 
offensive  discharge,  and  gives  rise,  like  the  preceding,  to  acute  pain, 
expressed  by  continual  movement  of  the  parts ;  sometimes  the  skin  of 
the  external  auditory  meatus  is  much  swollen,  and  the  conduit  itself 
obstructed.  Eczema  of  the  scrotum  is  remarkable  on  account  of  the 
swelling  and  very  acute  hyperaesthesia  of  the  inflamed  surface,  and  the 
abundance  of  the  discharge.  That  of  the  plantar  region  and  inter- 
digital  space  produces  lameness ;  sometimes  it  is  followed  by  sup- 
purating dermatitis  of  the  paw,  which  may  become  complicated  with 
sinus  formation  difficult  to  cure. 

Many  cases  of  eczema  at  present  under  treatment  in  hospital  are 


ECZEMA    IN    THE    DOG.  285 

localised  on  the  body,  neck,  and  ear.  In  one  the  upper  surface  of  the 
neck,  shoulders,  and  back  presents  a  large  inflamed  patch  partially 
denuded  of  hair,  and  almost  entirely  covered  with  a  viscous,  yellowish, 
purulent  material ;  the  skin  is  thickened,  infiltrated,  and  shows  trans- 
verse folds  ;  the  periphery  of  this  patch  is  sharply  circumscribed  by  a 
deep  red  sinuous  line,  outside  which  is  a  narrow  hyperaemic  zone.  In 
another  the  lower  surface  of  the  neck  is  the  seat  of  an  eczematous 
zone  offering  nearly  the  same  characters.  A  third  showed  a  few  days 
ago  a  discharging  and  very  painful  area  on  the  back.  The  process  has 
now  arrived  at  the  period  of  desiccation  ;  the  skin  is  covered  with  thin 
crusts,  is  no  longer  so  sensitive,  and  is  hardly  swollen.  In  a  poodle 
affected  with  double  otitis  externa,  marked  by  abundant  discharge  and 
great  sensitiveness,  the  integument  lining  the  external  ear  is  still 
swollen  and  red,  but  the  discharge  has  greatly  diminished,  is  no  longer 
offensive,  and  the  itching  has  disappeared.  Another  case  shows 
auricular  eczema  complicated  with  othasmatoma  (oedema  of  the  flap  of 
the  ear)  ;  the  incessant  shaking  of  the  ears  has  caused  separation  of 
the  skin  from  the  subjacent  tissues,  and  the  formation  of  a  cyst 
prominent  on  both  surfaces  of  the  flap  of  the  ear. 

Histological  study  of  the  lesions  of  acute  eczema  shows  that  the 
process  is  generally  limited  to  the  superficial  layer  of  the  dermis.  The 
rete  mucosum  is  the  seat  of  oedematous  inflammation,  and  of  a  more 
or  less  abundant  immigration  of  lymphatic  cells  ;  the  epidermis  is 
swollen  and  softened  by  the  exuded  serosity,  vesicles  form,  and  the 
epidermis  becomes  detached  or  exfoliated.  The  vesicles  develop  be- 
tween the  rete  mucosum  and  the  stratum  corneum  ;  they  contain  a 
serous  liquid,  leucocytes,  large  polynuclear  epithelial  cells,  and  micro- 
cocci. The  more  intense  the  inflammation,  the  greater  the  amount 
of  exudate  and  the  more  abundant  the  infiltration  of  leucocytes.  The 
inflammatory  changes  extend  to  the  entire  thickness  of  the  corium,  in 
which  purulent  centres  may  develop,  partial  destruction  of  tissue 
occur,  and  portions  of  the  papillary  layer  be  lost  in  consequence 
of  external  irritation.  To  sum  up,  acute  simple  eczema  is  an  exu- 
dative inflammation  affecting  the  dermis  and  epidermis,  and  producing 
lesions  comparable  to  those  of  a  superficial  catarrh  of  the  skin. 


XXXIX.— ECZEMA    IN    THE    DOG    (CONCLUSION). 

Chronic  eczema,  which  is  very  common  in  old  dogs,  succeeds  to 
acute  attacks  ;  or  may  develop  as  a  primary  condition,  and  then  pre- 
sents the  characters  of  the  squamous  form. 

It  also  most  frequently  affects  the  upper  regions  of  the  body  ;  in 
some  patients  it  is  confined  to  the  limbs,  and  more  particularly  to  the 
elbows  and  hocks.  It  may  continue  in  the  dry  stage  indefinitely, 
though,  as  pruritus  is  generally  severe,  certain  spots  are  apt  to  become 
irritated  by  scratching  or  rubbing,  and  moist  discharging  areas  develop 
in  consequence.  For  this  reason  most  animals  with  old-standing 
eczema  show  recent  areas  alongside  others  of  much  older  standing. 

The  affected  surfaces  in  chronic  eczema  present  an  appearance 
resembling  lichen  ;  the  hair  is  shed,  or  the  sparse  covering  left  is  rigid 
and  patchy  ;  the  skin  is  thickened,  dry,  and  squamous,  often  has  a 
granular  or  verrucous  appearance  in  consequence  of  hypertroph}^  of  the 
papillae,  and  is  usually  deeper  in  colour  than  that  of  neighbouring 
parts. 

The  process  produces  hardening  (sclerosis)  of  the  skin,  and  leads  to 
hyperplastic  and  atrophic  changes ;  the  cells  of  the  dermis,  the  glands, 
and  the  capillary  follicles  gradually  undergo  change,  and  may  partially 
disappear.  In  spite  of  exfoliation  of  the  superficial  layers  of  the  epi- 
dermis this  portion  of  the  skin  remains  of  considerable  thickness. 

As  in  the  acute  form,  circumscribed  patches  are  sometimes  seen 
which  remain  obstinate,  and  very  rebellious  to  treatment.  In  the 
dorso-lumbar  region  eczema  often  extends  over  very  large  spaces,  and 
in  old-standing  cases  produces  excessive  thickening  and  folding  of  the 
skin.  In  the  limbs  the  disease  affects  the  elbows,  hocks,  and  digital 
region  ;  in  some  animals  it  ends  by  producing  suppurative  dermatitis, 
marked  by  the  formation  of  numerous  little  abscesses  containing  blood- 
stained pus,  and  offering  almost  the  same  appearance  as  follicular 
mange.  Eczema  of  the  tail  sometimes  extends  to  the  greater  part  of 
this  region,  or  appears  as  a  large  number  of  small  disseminated  areas,  but 
is  most  frequently  localised  at  the  extremity,  the  skin  covering  which  is 
inflamed  and  swollen,  and  its  superficial  layer  ulcerated,  whence  the 


ECZEMA    IN    THE    DOG.  287 

name  "cancer  of  the  tail;"  the  remaining  hairs  at  this  point  are  stiff, 
dry,  and  fragile,  and  the  end  of  the  tail  is  often  indurated  for  a  distance 
of  an  inch  or  more.  The  diseased  parts  are  often  bitten  or  otherwise 
injured,  causing  bleeding  and  acute  recurrences  of  inflammation  ;  in 
this  way  the  disease  may  be  prolonged  for  months.  In  exceptional 
cases  eczema  may  produce  marked  thickening  of  the  epidermis  cover- 
ing the  caudal  extremity,  and  the  growth  of  little  confluent  horny 
patches.  Chronic  eczematous  inflammation  of  the  auditory  meatus 
produces  thickening  of  the  lining  membrane,  sometimes  ulceration  or 
hypertrophy  of  the  papillae,  and  vegetations  which  obstruct  the  passage. 

The  symptoms  of  eczema  are  sufficiently  characteristic  in  most 
cases  to  permit  of  diagnosis  solely  by  clinical  examination.  If  there  is 
any  doubt,  it  becomes  necessary  to  carefully  examine  all  the  affected 
parts,  their  appearance  and  character  frequently  allowing  of  an  opinion 
being  given  without  recourse  to  microscopic  examination.  Eczema 
can  always  be  differentiated  from  the  eruption  seen  during  distemper, 
from  favus  and  tinea  tonsurans,  and  from  various  traumatic  lesions  of 
the  skin  ;  but  certain  forms  may  be  mistaken  for  sarcoptic,  and  others 
for  follicular  mange.  We  recently  saw  a  dog  which  showed  a  patch  of 
impetiginous  eczema  on  the  neck,  closely  resembling  follicular  mange, 
and  eczematous  areas  often  simulate  recent  sarcoptic  mange.  In  these 
cases  the  question  can  only  be  decided  by  microscopic  examination  of 
material  obtained  by  scraping  the  diseased  surfaces  with  a  scalpel. 

The  prognosis  of  eczema  is  more  serious  than  that  of  other  skin 
diseases  of  the  dog,  except  follicular  mange  and  suppurating  derma- 
titis. It  is  not  particularly  difficult  to  temporarily  cure  animals,  but 
the  disease  frequently  reappears  after  a  varying  interval.  Although  all 
forms  of  eczema  are  not  equally  grave,  the  majority  imply  the  existence 
of  a  constitutional  condition  which  dominates  the  appearance  of 
disease.  The  prognosis  is  more  favourable  in  acute  than  in  chronic 
eczema,  and  in  localised  than  in  the  more  or  less  generalised  forms. 
Eruptions  on  the  ear,  foot,  and  tail  are  difficult  to  completely  cure  in 
certain  animals,  especially  in  those  beyond  middle  age.  Various  con> 
plications  are  possible.  Thus  eczema  of  the  ear  may  be  accompanied 
by  ulceration  of  the  base  of  the  conchal  cartilage — auricular  canker  ; 
by  othaematoma,  by  abscess  formation  at  the  base  of  the  ear  in 
consequence  of  rubbing,  and  later  by  deafness ;  eczema  of  the  eyelid 
is  sometimes  complicated  by  entropion,  or  even  by  ulcerative  keratitis  ; 
and  eczema  of  the  scrotum  may  be  follovv^ed  by  orchitis  due  to  rubbing, 
by  which  the  animal  seeks  to  allay  pruritus.     Whatever  the  seat  of 


258  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

the  eruption,  intra-  or  hypo-dermic  abscesses  and  loss  of  substance  of 
the  skin  aggravate  the  eczema  and  leave  cicatrices.  Finally,  the 
animal's  mode  of  life  plays  a  certain  part ;  in  lapdogs  eczema  is  more 
rebellious,  and  relapses  more  frequent  than  in  others. 

The  treatment  of  eczema  is  complex.  Many  practitioners  confine 
themselves  to  local  treatment,  but  in  most  patients  durable  results 
can  only  be  obtained  by  internal  medication,  and  change  in  the  method 
of  feeding. 

The  local  treatment  of  acute  eczema  is  best  commenced  as  follows: — 
The  hair  should  be  clipped  from  the  diseased  surface,  and  if  the  eczema 
is  extensive  and  generalised  the  animal  should  be  shaved  ;  the  skin  is 
next  washed  with  soap  and  water,  or  with  warm  boric  solution,  dried 
carefully,  and  afterwards  protected  as  far  as  possible  from  irritation  ; 
in  pet  dogs  the  rug  usually  may  require  to  be  removed,  and  in  no  case 
should  a  collar  be  used  if  an  area  of  eczema  is  developed  on  the  skin  of 
the  neck. 

In  moist  eczema,  once  the  diseased  surfaces  are  cleansed  and  dis- 
infected the  best  local  treatment  usually  consists  in  topical  dressing 
with  powders,  with  which  the  parts  are  dusted  two  or  three  times  per 
day.  Among  such  are  starch,  talc,  subnitrate  of  bismuth,  oxide  of 
zinc,  or  a  mixture  of  these  substances.  In  pet  dogs  these  powders 
may  be  slightly  perfumed,  and  rice  powder  substituted  for  starch. 

If  the  skin  irritation  is  very  acute,  warm  lotions  containing  chloral 
hydrate,  or  3  to  6  per  cent,  bicarbonate  of  soda  solution  ;  or,  again,  very 
dilute  alcohol,  with  the  addition  of  i  per  cent,  of  carbolic  acid,  may  be 
used  ;  and  the  parts  afterwards  dressed  with  a  preparation  of  glycerine, 
or  an  ointment  containing  the  same  proportion  of  carbolic  acid.  In 
the  limbs,  and  other  regions  which  the  animal  can  reach,  eczema  is 
often  kept  up  and  aggravated  by  licking.  The  diseased  surface  must 
then  be  protected  with  a  cotton-wool  dressing. 

Slight  cauterisation  of  the  inflamed  surface  has  sometimes  been 
practised,  for  which  purpose  either  10  per  cent,  nitric  acid  or  5  to  6 
per  cent,  nitrate  of  silver  solution  may  be  used.  The  spots  are  swabbed 
with  one  of  these  preparations  by  means  of  a  brush.  This  produces  a 
superficial  eschar,  and  leads  to  the  formation  of  a  thin  protective  crust, 
under  which  the  skin  dries  and  the  epidermis  is  renewed. 

In  acute  eczema  especially,  lotions  and  repeated  baths  are  incon- 
venient ;  water  irritates  the  skin,  keeps  up  or  even  increases  the 
inflammation,  and  may  produce  fresh  eruptions. 

In  impetiginous  eczema  the  pus  collected  under  the  crust  ma}'  be 
gently  squeezed  out,  the  crusts  themselves  removed  with  small  tampons 


ECZEMA    IN   THE    DOG. 


of  cotton  wool,  and  an  antiseptic  dressing  applied.  One  may  also  use 
with  advantage  5  per  cent,  aqueous  solution  of  carbolic  acid  or  of 
formalin ;  pure  glycerine,  or  glycerine  containing  a  trifling  proportion 
of  iodine  ;  zinc  ointment  ;  vaseline,  or  lanoline.  The  three  latter  can 
either  be  used  alone  or  with  the  addition  of  small  quantities  of  talc, 
oxide  of  zinc,  boric  acid,  salicylic  acid,  or  resorcin.  The  following  are 
useful  formulae  : 


(I) 

R 

Vaseline 100  parts 

Wax 20      „ 

Oxide  of  zinc    .         .         .         .       20      ,, 

(2) 

R 

Vasehne  or  lanoline  .         .         O  -l-        1 

^   .  ,      ^    .                                         I  Equal  parts. 

Oxide  of  zinc     .         .         .         .J 

(3) 

R 

Vaseline 100  parts. 

Talc 50      „ 

Oxide  of  zinc     .         .         .         •       50      5> 

(4) 

R 

Vaseline 100  parts. 

Oxide  of  zinc     .         .         .         .       50      ,, 

• 

Salicylic  acid     .         .         .         .         5      ,, 
Resorcin 2|    ,, 

In  the  squamous  forms  of  eczema  tar  and  creolin  are  the  applica- 

tions commonly 

used.     The  tar  may  be   applied  either  dissolved   in 

alcohol  or  mixed 

with  green  soap. 

(I) 

R 

Tar 100  parts. 

Alcohol 50      ,, 

(2) 

R 

Tar  and  green  soap  .         .         .     Equal  parts. 

(3) 

R 

Creolin 50  parts. 

Green  soap        .         .         .         .     50      ,, 
Alcohol 25      ,, 

The  chosen  preparation  is  applied  in  a  thin  layer  to  the  diseased 
parts  ;  crusts  form  and  crack,  and  can  be  removed  at  the  end  of  a 
week.  The  appearance  of  the  skin  indicates  whether  a  second  applica- 
tion is  necessary.  When  the  skin  is  moist  these  preparations  are 
inferior  to  powder  dressings. 

The  seborrhoeic  form  is  treated  by  the  application  of  glycerine  of 
starch  and  oil  of  cade  in  equal  parts ;  by  ointments  or  glycerina  con- 
taining 5  per  cent,  pyrogallic  acid,  5  to  10  per  cent,  salicylic  acid,  or 
10  per  cent,  of  sulphur. 

In  treating  chronic  eczema  the  chief  points  consist  in  softening 
and  detaching  the  crusts  or  scales,  disinfecting  the  diseased  surfaces, 
and  protecting  the  hyperaemic  skin  from  irritation.  The  crusts  are 
softened  and  cleared  away  by  applications  of  vaseline,  and  by  washing 

T 


2go  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

with  Castile  or  glycerine  soap.  The  skin  is  afterwards  dressed  with  a 
warm  solution  of  bicarbonate  of  soda,  or  better  still  with  one  of  the 
Hniments  just  mentioned  in  speaking  of  squamous  eczema. 

The  parts  are  occasionally  washed  with  soap  and  boiled  water,  to 
which  has  been  added  i  to  2  per  cent,  of  creolin,  or  with  the  solution 
of  bicarbonate  of  soda. 

Many  other  preparations,  and  certain  new  drugs  like  ichthyol, 
anthrarobin,  chrysarobin,  and  pyoctanin,  have  been  recommended 
during  the  last  few  years,  but  are  in  no  wise  superior  to  the  applications 
usually  employed. 

Internal  medication  is  useless  against  eczema  resulting  from  purely 
local  causes,  but  in  practice  it  is  impossible  to  clinically  distinguish 
between  such  attacks  and  those  of  constitutional  origin  ;  when  the 
disease  is  chronic  and  rebellious  internal  medication  is  always  indi- 
cated. In  eczema  there  is  no  unique  general  treatment,  and  no  drug  can 
lay  claim  to  the  character  of  a  specific.  Neither  alkaline  nor  arsenical 
preparations  suit  all  cases.  Although  the  former  are  valuable  at  various 
stages  of  the  disease,  they  are  particularly  useful  in  fat  or  obese  dogs  ; 
bicarbonate  of  soda  may  be  given  in  the  food  in  doses  of  15  to  90  grains 
per  day.  Purgatives  are  useful  in  acute  eczema  ;  under  their  influence 
the  cutaneous  patches  dry  more  readily.  Arsenical  preparations, 
especially  Fowler's  solution,  are  valuable  in  the  chronic  forms.  Fowler's 
solution  is  given  in  doses  of  i  to  6  drops  per  day.  Mineral  waters  like 
Vichy,  Evian,  or  La  Bourboule,  may  be  prescribed,  especially  for  pet  dogs, 
and  can  be  given  pure  or  mixed  with  milk.  Sublimed  sulphur  in  daily 
doses  of  15  to  30  grains,  cod-liver  oil  and  iron  salts  also  have  their  use. 

Finally,  it  must  be  borne  in  mind  that  hygiene,  diet,  and  healthy 
surroundings  have  an  unquestionable  influence  on  the  development  of 
eczema.  Depending  on  its  constitution  or  bodily  condition,  the  patient 
should  either  be  confined  to  light  nourishment,  to  meat,  boiled  milk, 
or  to  various  preparations  of  milk,  or  may  receive  a  mixed  diet.  In 
general  the  number  of  meals  should  not  be  diminished,  but  the  total 
daily  nourishment  should  be  cut  down.  If  the  patient  is  fat  it  must  be 
reduced  to  a  minimum  diet.  Pastry,  etc.,  should  be  forbidden.  Animals 
leading  a  confined  life  should  receive  regular  exercise. 

In  the  dog  good  hygiene  and  carefully  regulated  diet  often  have  at 
least  as  much  effect  on  the  course  of  eczematous  attacks  as  any  drug. 
Many  of  our  patients  are  under  unfavourable  conditions  for  complete 
cure,  so  that  when  their  condition  can  only  be  improved  it  is  usually 
better  to  return  them  home,  arrangements  being  made  for  steady 
exercise,  open-air  life  as  far  as  possible,  carefully  regulated  diet,  and 
every  week  or  two  internal  treatment. 


XL.— ECZEMA   IN   THE    HORSE. 

A  FEW  days  ago  you  saw  in  the  clinique  a  horse  with  recent  skin 
disease,  indicated  by  symptoms  resembling  those  of  granular  dermatitis. 
This  peculiar  appearance  had  struck  the  veterinary  surgeon  who  sent 
the  animal  to  me.  He  pointed  it  out,  and  suggested  that  the  disease 
resembled  the  "  heat  spots  "  seen  during  warm  weather. 

On  examining  the  patient  we  found  three  swollen  patches  covered 
with  yellowish-grey  broken  crusts,  from  between  which  a  sticky,  serous 
fluid  escaped.  One  of  these  patches,  situated  between  the  elbows,  w^as 
oval  in  shape  and  a  little  larger  than  a  man's  hand ;  another  on  the 
near  fore-leg  was  limited  to  the  external  surface  of  the  canon-bone  and 
fetlock ;  the  third,  in  a  similar  situation  on  the  off  hind  leg,  was  rather 
larger  in  size.  I  will  give  a  summary  of  the  clinical  history  of  this 
animal. 

Bay  brown,  seven-year-old  gelding,  of  lymphatic  character,  brought 
for  examination  and  left  for  treatment  on  the  6th  March. 

Being  attacked  with  bronchitis  towards  the  middle  of  last  January, 
this  animal  was  rested  for  nearly  three  weeks.  Since  convalescence  it 
has  worked  little.  The  skin  affection  originated  about  a  fortnight  ago. 
Three  patches,  from  which  the  hair  fell  away  and  discharge  occurred, 
successively  appeared,  one  on  the  near  fore-limb,  one  on  the  off  hind, 
and  one  on  the  chest. 

State  on  Examination. — The  patches  are  situated  as  follows: — The 
first  on  the  outer  surface  of  the  fetlock  and  pastern  of  the  near  fore- 
limb  ;  the  second  between  the  elbows ;  the  third  on  the  antero-external 
surface  of  the  right  hock.  The  latter  has  the  most  striking  appearance. 
At  the  present  moment  almost  its  entire  surface  is  denuded  of  hair  and 
discharging.  At  certain  points  the  exudate  is  serous  and  trifling  in 
amount ;  at  others  there  are  little  erosions  covered  with  a  thin,  sticky, 
yellowish  layer  formed  of  dry  exudate ;  when  exposed  the  dermis  is  of 
a  more  or  less  bright  red,  and  appears  finely  punctated.    In  other  places^ 


292  CLINICAL   VETERINARY    MEDICINE    AND    SURGERY. 

where  inflammation  is  more  intense,  granulations  have  developed,  rising 
a  few  millimetres  above  the  level  of  the  skin,  and  secreting  a  sero- 
sanguinolent  liquid,  which,  together  with  the  epidermal  cells,  etc., 
forms  a  material  gluing  together  the  hairs  surrounding  the  patch. 
The  patch  itself  is  encircled  by  a  band  of  skin  covered  with  vesicles 
resulting  from  a  fresh  attack.  Sensation  is  not  specially  acute  at  any 
point,  but  there  is  intense  pruritus,  which  the  animal  betrays  by  biting 
or  continually  rubbing  the  parts.  Despite  the  use  of  a  cradle  it  still 
attempts  to  bite,  and  has  several  times  rubbed  the  diseased  spots, 
causing  them  to  bleed.     There  is  no  lameness. 

The  patch  on  the  near  fore-limb  is  less  bare  than  the  preceding  ;  its 
upper  part  is  becoming  dry,  but  its  lower  still  discharges.  At  first  sight 
the  disease  recalls  horse-pox,  or  a  recent  attack  of  grease,  but  the  offen- 
sive odour  and  the  vegetations  characteristic  of  the  latter  are  absent. 
Examined  more  closely,  this  surface  shows  the  same  characters  as  the 
patch  on  the  right  hock.  There  is  a  certain  degree  of  itching  and  of 
local  swelling,  but  no  lameness. 

The  third  patch  occupies  the  entire  space  between  the  elbows  and 
the  upper  internal  surface  of  both  fore-limbs.  It  is  covered  with  pale 
yellow,  thin,  sticky  crusts,  while  the  skin  is  swollen,  infiltrated,  and 
shows  a  series  of  broad  folds  separated  by  depressions  in  which  secre- 
tion is  abundant.  Like  the  two  others,  this  patch  is  the  seat  of 
extreme  pruritus.  The  continuous  movement  of  the  limbs  keeps  up 
acute  inflammation. 

The  general  condition  is  good.    The  principal  functions  are  normal. 

The  characters  of  the  patches,  the  presence  of  isolated  vesicles 
around  them,  their  almost  simultaneous  appearance  in  several  separate 
spots,  and  their  mode  of  development,  leave  little  doubt  as  to  the  dia- 
gnosis. The  negative  result  of  inoculation  with  the  exudate  clearly 
shows  the  condition  to  be  moist  eczema. 

Treatment  consisted  in  clipping  away  the  hair  from  around  the 
patches  on  the  limbs,  disinfecting  the  surfaces  with  warm  creolin 
solution,  drying,  and  applying  a  powder  composed  of  four  parts  starch 
and  one  part  oxide  of  zinc ;  finally,  administering  internally  sulphate 
and  bicarbonate  of  soda. 

Considerable  improvement  was  noted  from  the  third  day.  The 
patch  on  the  near  fore-limb  discharged  less,  except  under  the  pastern, 
where  in  consequence  of  movement  the  granulations  had  been  torn 
through.  In  the  off  hind  limb  the  disease  had  extended  to  the  lower 
portion  of  the  canon-bone  and  fetlock,  developing  with  great  rapidity ; 
eruption,  vesiculation,  and  rupture  of  the  vesicles  occurring  in  twenty- 
four  to  forty-eight  hours.     The  patch  between  the  elbows  was  much 


ECZEMA    IN    THE    HORSE.  293 

less  swollen ;  the  crusts  were  thinner,  and  on  being  removed  revealed 
a  rose-coloured  granulating  surface. 

On  the  13th  improvement  continued.  The  diseased  surfaces  on 
the  fore  and  hind  limbs  were  almost  completely  dry,  and  in  a  fair  way 
to  heal.  Nevertheless  around  the  flexures  of  the  pastern  and  hock 
the  continued  movement  had  resulted  in  formation  of  superficial 
cracks.     These  were  dressed  with  boric  vaseline. 

On  the  15th  these  two  patches  were  entirely  healed,  and  the  third 
discharged  less  abundantly. 

On  the  20th  the  surface  between  the  elbows  had  become  dry. 

The  foregoing  gives  an  exact  idea  of  the  characters  of  the  skin 
lesions  in  our  patient.  Certainly  they  in  no  way  resemble  those  of 
granular  dermatitis.  Apart  from  the  fact  that  this  disease  neither 
appears  nor  returns  at  the  present  time  of  year,  the  superficial  lesions 
that  you  saw  had  not  the  essential  characters  of  this  parasitic  der- 
matitis :  the  skin  was  only  moderately  swollen,  the  diseased  surfaces 
were  only  granular  at  certain  points  in  consequence  of  mechanical 
irritation,  and  the  pruritus  rapidly  diminished.  Nor  was  the  disease 
like  urticaria  or  any  form  of  mange,  which  usually  occupies  positions 
and  shows  symptoms  entirely  differing  from  those  we  noted.  As  to 
horse-pox,  the  cutaneous  lesions  of  which  often  simulate  acute  eczema, 
we  eliminated  it  by  the  negative  results  attending  inoculation  of  several 
horses. 

The  disease  was  a  simple  eczematous  eruption,  the  most  striking 
features  of  which  were  its  position  and  the  small  extent  of  the  affected 
surfaces. 

During  two  of  our  preceding  lectures  I  devoted  considerable  atten- 
tion to  the  stages  of  development  and  different  forms  of  eczema  in  the 
dog.  To-day  I  wish  to  speak  of  the  same  disease  in  the  horse,  in 
which,  however,  it  is  much  less  common  than  in  the  dog.  The  forms 
seen  include  acute  and  chronic,  sometimes  generalised,  sometimes  con- 
fined to  certain  regions. 

The  disease  is  usually  more  or  less  generalised.  A  discrete  papular 
eruption  appears,  accompanied  by  itching ;  the  points  soon  become 
more  numerous,  the  itching  increases,  and  the  papules  are  converted 
into  vesicles  and  burst  spontaneously,  or  are  ruptured  by  rubbing. 
Where  the  skin  is  fine  the  eruption  is  often  vesicular  from  the  first. 
The  contents  of  the  blisters  spread  over  the  skin,  glue  together  the 
hairs  into  little  tufts,  and  afterwards  dry,  forming  small  yellowish  or 
greyish    crusts,    sometimes   deeper   tinted    on    account   of  the    blood 


294  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY, 

present.  Trifling  suppuration  occurs,  raising  and  detaching  the  crusts, 
which  carry  with  them  a  portion  of  the  hairs  covering  the  skin  at  that 
point,  and  thus  produce  the  bare  surfaces  seen  during  the  final  stage 
of  the  eruption.  The  crusts  having  fallen  suppuration  ceases,  the 
dermis  again  becomes  covered  with  a  thin  dry  layer,  under  which  the 
epidermis  re-forms,  and  the  skin  gradually  resumes  its  normal  ap- 
pearance. 

Some  weeks  ago  you  saw  in  an  eight-year-old  cart-horse  a  remark- 
able outbreak  of  generalised  eczema.  The  skin  of  the  trunk  was  dotted 
over  with  small  greyish  circular  crusts  a  few  millimetres  in  thickness, 
over  which  the  hairs  were  glued  together  in  tufts.  The  disease  had 
appeared  about  ten  or  twelve  days  before.  This  horse  first  showed 
loss  of  appetite  and  depression,  followed  by  the  sudden  eruption  of 
vesicles  over  a  wide  surface.  When  brought  here  we  noted  nothing 
abnormal  save  the  cutaneous  disease  ;  neither  the  animal's  general 
health  nor  the  various  functions  were  in  the  smallest  degree  disturbed ; 
not  even  the  mucous  membranes  showed  anything  unusual. 

Successive  attacks  of  an  acute  or  subacute  character  may  develop, 
a  fresh  eruption  occurring  before  the  disappearance  of  the  preceding, 
so  that  lesions  of  varying  age  are  often  associated  and  combined, 
forming  a  complex  polymorphic  clinical  picture.  In  some  cases  the 
skin  finally  becomes  almost  entirely  covered  with  crusts. 

Instead  of  thus  extending,  eczema  may  be  limited  to  certain 
regions.  It  is  commonest  in  those  exposed  to  mechanical  irritation, 
like  the  head,  withers,  front  of  the  shoulders,  back,  croup,  and  girth, 
where  the  different  portions  of  the  harness  exercise  pressure  and 
continual  friction  ;  behind  the  elbow,  or  in  the  groin,  where  the  folds 
of  skin,  which  are  frequently  covered  with  sweat,  produce  mutual 
friction  during  movement ;  on  the  flexion  surfaces  of  the  joints  of  limbs, 
especially  the  lower  joints,  where  the  skin  forms-  folds  and  is  ex- 
posed to  the  action  of  wet  or  mud,  or  is  covered  with  scurf,  dust,  or 
manure ;  on  surfaces  covered  with  long  hair,  such  as  the  upper  margin 
of  the  neck  and  tail  (parts  specially  aff"ected  by  parasites,  like  lice  and 
trichodectes),  and  at  points  where  the  skin  is  kept  moist,  or  is  not 
cleaned.  Circumscribed  eczematous  patches  show  the  same  features 
as  the  generalised  form.  Once  the  vesicles  rupture,  the  skin,  as  in 
exudative  dermatitis,  is  seen  to  be  swollen  and  discharging,  while  the 
margins  of  the  inflamed  areas  still  exhibit  a  few  vesicles. 

Instead  of  terminating  in  recovery  eczema  may  assume  the  chronic 
form.  The  skin  becomes  thickened,  wrinkled,  irregular,  and  squamous  ; 
sometimes  it  is  covered  with  thick  crusts,  or  shows  superficial  cracks. 


ECZEMA    IN    THE    HORSE.  295 

This  chronic  eczema  produces  permanent  changes  in  the  skin.  The 
chief  consists  in  more  or  less  abundant  cellular  infiltration  of  the  corium, 
especially  around  the  folds ;  dilatation  of  the  lymph  vessels ;  hyper- 
trophy of  the  papillae ;  and  sometimes  a  fibrous  change  in  the  dermis, 
with  atrophy  of  the  glands  and  hair  follicles.  The  changes,  in  fact, 
are  those  of  sclerosis. 

Eczema  especially  tends  to  become  chronic  in  parts  irritated 
by  harness  and  in  the  flexures  of  the  knee,  hock,  and  phalangeal 
joints.  For  a  long  time  all  transverse  cracks  in  the  skin  over  the 
flexures  of  joints  were  wrongly  considered  simple  accidents,  due  to 
physical,  chemical,  or  thermic  causes.  Undoubtedly  many  cases  are 
due  exclusively  to  local  influences — during  cold  weather  to  the  action 
of  snow,  mud,  or  water  ;  but  the  transverse  cracks  which  develop  in  these 
regions  and  prove  so  obstinate  (mallenders  and  sallenders)  are  often 
eczematous  in  character.  Their  aetiology  is  dominated  and  their 
persistence  and  chronic  character  explained  by  some  peculiarity  in  the 
animal's  constitution.  Last  month  you  saw  in  the  external  clinique  a 
seven-year-old  Norman  horse  which  had  been  ineffectually  treated  for 
nearly  a  year  for  numerous  comparatively  superficial  cracks  under  both 
front  pasterns.  The  choice  of  applications  had  certainly  not  always 
been  happy.  Previous  to  coming  here  the  parts  had  been  dressed  with 
an  ointment  containing  lard,  which  had  formed  a  layer  of  decomposing 
irritant  material,  contributing  in  no  small  measure  to  the  continuance 
of  the  disease.  We  prescribed  local  antiseptic  treatment  and  internal 
medication.  The  horse  returned  here  a  few  days  ago,  and  you  saw 
that  already  great  improvement  had  occurred.  I  have  collected  a 
number  of  similar  cases  in  which  success  appeared  due,  in  part  at  least, 
to  internal  treatment,  a  fact  which  shows  how  far  these  attacks  are 
dependent  on  the  general  state  of  health,  or  on  some  disturbance  of 
nutrition. 

In  the  horse  cases  of  essential  as  well  as  of  symptomatic  eczema 
are  seen,  but  almost  all  obstinate  attacks  depend  on  some  disturbance 
in  the  general  health. 

As  I  said  before  in  speaking  of  canine  eczema,  it  is  probable  that 
microbes  living  on  the  skin,  or  at  least  some  of  them,  play  a  part  in  pro- 
ducing certain  forms  of  eczema,  though  even  in  "  grease  "  this  part  is 
at  present  ill-defined. 

In  the  horse  certain  eczematoid  diseases  of  the  foot  and  lower  parts 
of  the  limbs  are  remarkable  both  for  their  clinical  appearance  and 
obstinate  character.  Chronic  exudative  and  hypertrophic  dermatitis  of 
the  pastern — vulgarly  known  as  "grease" — is  characterised  by  a  dis- 


296  CLINICAL   VETERINARY    MEDICINE    AND    SURGERY. 

charge,  by  staring  of  the  hair,  and  by  verrucous  growths  due  to  hyper- 
trophy of  the  papillary  layer.  Chronic  vegetating  dermatitis  of  the 
foot — canker — produces  similar  hypertrophic  changes  in  the  horn- 
secreting  structures  of  the  sole,  principally  in  the  velvety  tissue,  at  the 
same  time  destroying  a  greater  or  less  area  of  the  horny  sole.  Chronic 
dermatitis  of  the  coronet — inflammation  of  the  perioplic  ring — pro- 
duces disturbance  in  the  secretion  of  periople  and  increases  and 
hardens  the  superficial  layers  of  skin  around  the  coronet. 

Whilst  the  latter  disease  is  principally  seen  in  plethoric  or  nervous 
patients,  the  two  former  (whose  development  is  favoured  by  the  local 
action  of  moisture  and  of  urine,  etc.)  are  almost  always  confined  to 
lymphatic  animals,  and  may  be  regarded  as  special  morbid  conditions 
having  a  distant  connection  with  the  usual  forms  of  eczema. 

The  prognosis  of  the  various  forms  of  eczema  in  the  horse  is 
favourable.  In  the  acute  forms  recovery  is  easy  and  almost  always 
rapid.  The  chronic  forms  generally  yield  to  suitable  local  and  general 
treatment.  Mallenders  and  sallenders,  which  may  also  involve  lame- 
ness, are  the  most  obstinate  complications. 

In  acute  eczema  the  first  indication  is  to  thoroughly  cleanse  and 
protect  the  diseased  surfaces  from  irritation.  If  secretion  is  abundant, 
absorbent  powders,  like  simple  starch  powder,  or  starch  powder  with 
the  addition  of  a  little  bismuth  or  oxide  of  zinc,  may  be  used.  Gly- 
cerine, iodine-glycerine,  more  or  less  strong  antiseptic  solutions,  and  a 
large  number  of  ointments  have  also  been  successfully  employed. 
The  good  results  obtained  from  all  these  agents  are  easy  to  explain, 
inasmuch  as  we  know  that  in  acute  eczema  recovery  occurs  spontane- 
ously in  a  period  seldom  exceeding  three  weeks  to  a  month.  Where 
itching  is  very  severe,  ointments  or  glycerina  containing  i  per  cent, 
of  carbolic  acid,  or  analgesic  preparations  like  solutions  of  cocain  may 
be  tried,  though  the  latter  require  frequent  application. 

If  the  attack  is  prolonged  or  recurrent,  internal  treatment  becomes 
necessary.  Arsenious  acid.  Fowler's  solution,  alkalies,  or  even  iodide 
of  potassium  may  be  used.  In  certain  cases  the  diet  requires  to  be 
changed. 

In  chronic  eczema  the  diseased  surfaces  must  first  be  cleansed, 
either  with  water  alone  or  with  soap  and  water,  and  the  process 
repeated  sufficiently  often  to  keep  the  skin  perfectly  clean.  After 
drying,  the  parts  may  be  dressed  with  vaseline,  containing  carbolic  acid 
or  creolin,  or  with  one  of  the  liniments  recommended  for  the  dog. 
Occasionally  it  is  very  useful  to  apply  a  surgical  dressing  for  several 


ECZEMA    IN    THE    HORSE.  297 

days,  in  order  to  protect  the  diseased  skin  from  irritation.  This 
method  is  particularly  valuable  when  animals  affected  with  eczema 
about  the  lower  parts  of  the  limbs  are  obliged  to  work  in  wet  weather 
or  on  muddy  roads. 

Internal  medication  comprises  alkalies  and  arsenical  preparations, 
which  may  be  given  alternately  for  periods  of  a  fortnight  ;  bicarbonate 
of  soda  in  daily  doses  of  one  to  two  ounces,  followed  by  arsenious  acid 
in  daily  doses  of  seven  to  fifteen  grains.  Between  the  two  courses 
treatment  should  be  suspended  for  intervals  of  one  week. 

Chronic  vegetating  dermatitis  of  the  pastern  (grease)  is  treated  b}' 
cleansing  the  skin  with  warm  antiseptic  solutions,  and  applying  astrin- 
gents or  slightly  caustic  preparations  daily,  or  at  intervals  of  several  days. 
Villate's  solution,  5  to  6  per  cent,  solution  of  sulphate  of  copper,  2  per 
cent,  solution  of  chromic  acid,  and  '2  to  *3  per  cent,  watery  or  alcoholic 
solutions  of  sublimate,  or  of  formalin,  appear  to  give  the  best  results. 

Chronic  dermatitis  of  the  coronet  is  dealt  with  by  applications  of 
tar,  of  tar  and  vaseline,  or  of  slightly  caustic  solutions,  and  by  thin- 
ning the  wall  of  the  hoof  opposite  the  diseased  spot. 

Vegetating  dermatitis  of  the  foot — canker — necessitates  exposure  of 
the  entire  invaded  surface  of  the  sensitive  sole  and  excision  of  the 
vegetations.  The  parts  are  then  dressed  with  antiseptics,  astringents, 
or  caustics,  care  being  taken,  however,  not  to  destroy  the  dermis  and 
subjacent  tissues. 

In  these  forms  of  dermatitis  it  is  also  well  to  administer  some  pre- 
paration of  arsenic.  The  drug  is  given  for  periods  of  a  fortnight, 
treatment  remitted  for  a  week  and  again  continued.  In  this  way 
arsenic  may  be  employed  for  long  periods. 


PART    III. 
CLINICAL    CASES. 


I.— HEAD    AND    SPINAL    CORD. 

K.— CRANIUM,   BRAIN,  AND   SPINAI    CORD. 

SUPERNUMERARY   TOOTH    IN    THE    TEMPORAL    REGION— OPERATION- 
SUPPURATING    MEDIAN    OTITIS. 

I.  Three-year-old  gelding,  left  in  hospital  23rd  January,  1897. 

About  two  months  previously  a  gradually  increasing  swelling  had 
appeared  at  the  base  of  the  left  ear.  On  the  20th  Januar}'  a  long 
streak  of  pus  was  seen  running  over  the  face.  A  veterinary  surgeon 
who  was  consulted  spoke  of  operation,  and  recommended  the  animal 
being  sent  to  Alfort. 

Condition  on  Entry . — A  hard  swelling,  as  large  as  a  hen's  egg,  and 
of  bony  consistence,  was  seen  a  little  in  front  of  the  base  of  the  left 
ear.  On  the  anterior  surface  of  the  scutiform  cartilage  was  a  sinuous 
orifice,  which  discharged  considerable  quantities  of  greyish  pus. 

Diagnosis. — Supernumerary  tooth  (dental  ectopia). 

Treatment. — On  the  25th  January  the  animal  was  cast  by  means  of 
Daviau's  table.  After  clipping  away  the  hair  and  preparing  the  parts 
the  sinus  was  explored,  and  found  to  be  about  4  inches  in  depth,  and 
to  terminate  over  a  dental  prominence.  The  skin  was  incised  for  a 
length  of  3|-  inches  over  the  swelling,  parallel  with  the  long  axis  of  the 
head.  The  margins  of  the  wound  were  drawn  apart,*  and  the  super- 
numerary tooth  exposed  by  a  second  slight  incision.  The  tooth,  which 
was  fixed  in  the  temporal  bone  over  the  origin  of  the  zygomatic  pro- 
cess, could  not  be  removed  with  the  strong  dental  forceps  used.  It  was 
therefore  left  in  position.  The  wound  was  cleansed  and  a  plug  of 
iodoform  gauze  applied,  over  which  the  lips  of  the  wound  were  reunited 
by  a  few  sutures.     The  tampon  was  removed  next  day. 

During  the  next  few  days  the  cavity  was  washed  out  with  an  anti- 
septic night  and  morning.  At  the  owner's  request  a  further  operation 
was  undertaken  on  the  2nd  February. 

The  animal  having  been  cast  the  tooth  was  again  freely  exposed, 


SUPPURATING    MEDIAN    OTITIS.  299 

though  a  fresh  incision  was  not  necessary.  The  wound  having  been  dis- 
infected a  groove  was  cautiously  excavated  around  the  tooth  by  means 
of  a  gouge  and  hammer,  and  unsuccessful  attempts  made  to  loosen  it. 
As,  however,  the  tooth  was  very  deeply  implanted^  and  extraction 
might  possibly  have  caused  injury  to  the  brain,  the  operation  was 
stopped.  The  wound  was  cleansed  and  plugged  with  iodoform 
gauze,  the  skin  brought  together  with  a  couple  of  sutures,  and  the 
horse  allowed  to  rise.  Although  every  precaution  had  been  observed 
the  animal  showed  grave  symptoms.  The  head  was  held  pendent,  a 
little  inclined  to  the  left  ;  movement  was  very  difficult ;  the  fore-limbs 
were  planted  wide  apart,  and  yielded  on  movement,  allowing  the 
animal  to  fall  on  its  knees.  It  at  once  rose,  but  was  unsteady  on  its 
legs.  A  deep  bed  of  straw  having  been  spread  around  it,  the  patient 
lay  down.  It  rose  in  half  an  hour,  and  was  then  placed  in  its  box. 
During  the  evening  it  took  some  sloppy  food. 

.  Next  day  it  was  found  standing  but  greatly  depressed ;  the  head 
was  held  low  and  still  inclined  to  the  left ;  the  fore-limbs  were  planted 
widely  apart.  The  animal  was  led  out  and  moved  a  few  steps  ;  the 
gait  was  slow,  uncertain,  and  vacillating.  At  certain  moments  rolling 
of  the  eyes  occurred.  The  wound  was  washed  and  plugged  with 
iodoform  gauze. 

On  returning  to  its  box  the  animal  attempted  to  eat.  It  took  some 
sloppy  food  and  a  little  hay.  At  first  we  suspected  intra-cranial 
haemorrhage,  but  as  the  circulation  and  respiration  became  more  rapid, 
and  the  temperature  rose  to  40*3°  C.  (i04'5°  F.),*  we  concluded  that  the 
mechanical  injury  was  complicated  with  meningo-encephalitis.  Affu- 
sions of  cold  boric  solution  were  made  to  the  head,  the  wound  was 
washed  with  2  per  cent,  creolin  solution,  iodide  of  potassium  was  given, 
and  the  food  confined  to  mashes  and  milk. 

On  the  4th  February  the  respiration  was  rapid  and  short,  36  per 
minute  ;  temperature  39*8°  C.  The  pulse  was  very  small  and  un- 
countable. 

On  the  5th  the  respiration  was  still  rapid  and  the  pulse  feeble.  The 
animal  was  sleepy,  had  no  appetite,  and  only  seemed  able  to  masticate 
its  hay.  Although  held  very  low  the  head  was  less  inclined  to  the 
left,  and  movement  was  less  painful.  Temperature  39*4°  C.  Treatment 
as  before.     The  evening  temperature  rose  to  41°  C. 

On  the  6th  the  condition  remained  the  same  ;  temperature  40°  C. 
Next  day  there  was  slight  improvement  ;  temperature  39'6°  to 
39'9°  C.  Respiration  was  less  rapid ;  appetite  fair  ;  difficulty  existed 
in  swallowing. 

On  the  8th  the  general  condition  was  a  little  improved.  The 
patient  left  the  corner  of  the  box  in  which  it  had  been  standing, 
moved  about  with  some  freedom,  and  ate  its  oats  and  mash.  Ha}- 
and  straw  were  slowly  chewed,  the  food  dropped  out  of  the  mouth 
and  again  picked  up ;  occasionally  a  little  was   swallowed,  but  with 

*  As  the  Centigrade  scale  is  now  largely  used,  and  the  constant  addition  of  the  Fahren- 
heit temperature  would  prove  very  cumbrous  in  these  clinical  records,  I  have  printed  in  the 
Appendix  a  comparative  chart  showing  the  exact  equivalent  on  the  Fahrenheit  scale  of  any 
given  Centigrade  temperature.     To  this  readers  are  kindly  referred. — Jxo.  A.  W.  D. 


300  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 

great  difficulty.  The  eyelids  were  swollen,  the  eyes  discharging, 
the  mucous  membranes  injected,  the  pulse  48,  respirations  24,  tem- 
perature 39*5°  C.  That  evening  the  animal  was  greatly  depressed ;  it 
even  left  its  mash.     Pulse  60  ;  respirations  20  ;  temperature  40*2°  C. 

From  the  9th  to  the  12th  the  condition  became  aggravated,  and 
the  comatose  symptoms  more  marked.  The  temperature  varied  be- 
tween 40°  and  41°  C.  Death  occurred  during  the  night  between  the 
I2th  and  13th  February. 

Autopsy. — The  lung  contained  several  metastatic  abscesses  as  large 
as  a  hazel-nut,  and  a  considerable  number  of  smaller  sized  gangrenous 
spots.  The  guttural  pouches  were  full  of  a  liquid  grumous  pus.  On  saw- 
ing through  the  mesial  line  of  the  cranium  its  internal  surface  appeared 
healthy,  and  the  meninges  of  the  brain  were  only  slightly  injected. 
The  left  ear  showed  deep-seated  suppurative  otitis ;  the  middle  ear  was 
full  of  foetid  pus.  In  spite  of  the  precautions  taken  during  operation 
the  petrous  temporal  bone  had  been  fractured  and  the  wound  infected. 
Pus  collected  from  the  ear  and  from  the  pulmonary  abscesses  contained 
streptococci. 

The  tooth  passed  obliquely  downwards  and  slightly  backwards 
through  the  entire  thickness  of  the  temporal  bone. 

[An  interesting  article  on  dentigerous  cysts  will  be  found  in  The 
Veterinarian  for  1899,  p.  309.] 

TUMOUR    OF    THE    RIGHT    HEMISPHERE    OF    THE    BRAIN. 

2.  A  five-year-old  entire  horse,  brought  for  examination  on  the 
i8th  August,  1896.  For  some  time  past  this  horse  had  shown  signs  of 
"  immobilite  "  (ventricular  dropsy  of  the  brain).  It  became  useless  for 
work,  no  longer  obeying  the  rein  and  stumbling  over  obstacles  in  the  road. 

On  first  examining  the  animal  we  were  struck  by  its  peculiar 
attitude.  The  head  and  neck  were  stiff;  the  neck  was  slightly  concave 
on  the  right  side ;  the  head  was  inclined  downwards  and  towards  the 
left. 

At  rest  the  animal  appeared  unsteady  on  the  limbs  of  the  near  side. 
When  alone  in  its  box  it  brought  the  legs  closely  together,  half  flexing 
the  fore-limbs  as  though  about  to  lie  down ;  then  it  began  to  turn 
towards  the  right  in  an  ever-decreasing  circle  until  it  pivoted  on  the 
hind  limbs  ;  finally  it  swayed  and  fell  on  the  right  side.  It  showed 
great  difficulty  in  rising,  and  had  to  be  assisted.  The  hind  limbs 
appeared  almost  helpless.  If  the  fore-limbs  were  crossed  the  animal 
remained  in  this  position,  like  a  horse  with  "  immobilite." 

It  was  quite  unable  to  walk  in  a  straight  line,  but  continually  turned 
towards  the  right,  and  could  not  be  made  to  trot,  though  it  was  able  to 
back  with  ease.  The  lumbar  region  was  excessively  sensitive,  and 
pressure  over  it  caused  the  animal  to  fall. 

Vision  was  abolished  in  the  right  eye  ;  the  eyelids  were  mobile  ;  the 
pupil  was  dilated  ;  the  various  media  of  the  eye  showed  no  disturbance. 
Examined  with  the  ophthalmoscope,  the  papilla  appeared  markedly 
hypersemic  ;  the  vascular  striae  were  very  visible,  especially  towards  the 
margins.     Hearing  seemed  less  acute  than  normal. 


TUMOUR    OF    THE    RIGHT    HEiAHSPHERE    OF    THE    BRAIN.  30I 

The  lips  and  tongue  were  not  paralysed.  Mastication  and  de- 
glutition were  normal,  and  the  appetite  was  perfectly  good.  General 
sensation  was  diminished,  except  in  the  region  of  the  head  and  limbs. 

The  animal  was  moderately  nourished.  Temperature  37*5°  C.  ; 
pulse  56  ;  respirations  14. 

During  the  few  days  the  horse  was  under  observation  the  symptoms 
remained  without  notable  change ;  there  was  no  vertigo  or  excitement. 
On  the  evening  before  the  animal  was  slaughtered  it  fell  on  the  right 
side,  and  was  unable  to  rise  again. 

Autopsy. — The  lesions  were  confined  to  the  brain,  the  surface  of 
which,  however,  showed  nothing  abnormal.  On  the  inner  surface  of 
the  right  hemisphere,  in  the  white  substance,  was  a  large  softened  area 
occupying  almost  all  the  upper  part  of  the  ventricle ;  it  measured 
3j  inches  from  front  to  back,  about  2  inches  transversely,  and  about 
I  to  I  of  an  inch  in  thickness,  depending  on  the  spot  measured.  It 
was  not  clearly  circumscribed,  and  penetrated  in  various  directions  into 
the  grey  substance.  Throughout  its  entire  extent  the  nervous  sub- 
stance was  of  a  reddish-grey  tint,  resembled  jelly,  and  of  semi-liquid 
consistence  ;  the  surface  of  sections  showed  a  few  small  hsemorrhagic 
spots. 

Studied  after  hardening  in  chromic  acid,  the  morbid  tissue  seemed 
formed  of  cells  with  large  nuclei  and  a  small  amount  of  protoplasm, 
isolated  or  united  in  little  groups,  and  provided  with  long  processes 
forming  a  kind  of  reticulum,  the  meshes  of  which  contained  round- 
cells.  The  growth  was,  therefore,  not  produced  by  degeneration,  as  we 
had  at  first  supposed,  but  was  a  true  tumour,  the  particular  form  being 
that  known  as  glioma. 

TUMOUR    OF    THE    RIGHT    HEMISPHERE    OF    THE    BRAIN. 
3.  A  seven-year-old  greyhound  bitch,  left  in  hospital  7th  October, 

Like  most  of  such  animals,  this  bitch  was  very  irritable.  As  testified 
by  her  own  owner,  in  whose  possession  she  had  always  been,  her  health 
had  until  the  commencement  of  1892  been  uniformly  good.  At  that 
time  a  tumour  had  been  discovered  in  the  mammary  gland,  and  had 
been  removed  by  a  veterinary  surgeon.  The  operation  wound  healed 
rapidly.  During  October  another  tumour  appeared  in  the  gland,  and 
in  July,  1893,  was  removed.     The  wound  closed  rapidly. 

Some  weeks  later  the  animal  showed  a  hoarse,  dry  cough,  which 
occurred  in  prolonged  attacks,  and  was  followed  by  attempts  at 
vomiting  :  the  attacks  became  progressively  more  frequent.  The  patient 
soon  lost  breath  when  walking,  and  was  regarded  as  asthmatic.  During 
August  and  September  she  was  taken  to  the  sea-side  by  her  owner. 
There,  we  were  told,  her  condition  improved,  until  one  day  during  a 
walk  in  the  country  she  came  too  near  a  cow,  and  began  to  run, 
yelping  loudly  ;  suddenly  she  stopped,  her  limbs  became  stiff,  she  fell 
senseless,  and  remained  in  that  condition  for  twenty  minutes.  Although 
no  trace  of  injury  could  be  seen  on  the  surface  of  the  body,  it  was 
thought  that  she  had  been   kicked.     Having  been    taken    home,  she 


302  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

several  times  during  the  evening  showed  signs  of  violent  excitement. 
Next  day  she  had  regained  her  usual  condition. 

A  fortnight  later  fresh  attacks  occurred  without  any  evident  cause. 
When  they  came  on,  the  patient,  if  standing,  was  taken  with  cramp  ; 
the  fore-limbs  were  stretched  out  to  their  fullest  extent,  then  the  hind 
limbs  collapsed  ;  the  animal  fell  towards  the  left  and  remained  pros- 
trate, the  entire  body  trembling;  sometimes  she  howled  as  though  in 
pain.  During  these  attacks,  which  lasted  from  ten  minutes  to  a 
quarter  of  an  hour,  the  head  was  strongly  inclined  to  the  left. 

Towards  the  end  of  September  the  disease  became  aggravated  ;  the 
appetite,  which  had  previously  been  good,  graduall}-  diminished,  the 
animal  remaining  for  whole  days  without  taking  food.  She  no  longer 
barked  ;  urine  and  faeces  were  passed  in  her  kennel.  During  the  night 
she  often  seemed  subject  to  great  excitement.  Nevertheless  on  certain 
days  the  disturbance  was  much  less  marked.  One  morning  she  was 
walked  nearly  two  miles  without  showing  unsteadiness,  without 
stopping,  and  without  any  apparent  disturbance  of  movement. 

Such  was  the  history  given  when  the  animal  was  brought  here. 

She  was  left  in  hospital.  The  sjmiptoms  noted  on  the  first  exami- 
nation were  as  follows : — The  face  was  dull  and  expressionless ;  the 
animal  reeled  on  her  limbs ;  movements  were  slow  and  irregular ;  the 
fore-limbs  showed  irregular  contractions ;  the  head  was  extended  on 
the  neck,  and  inclined  towards  the  ground  or  to  the  left ;  the  back  was 
arched.  Sometimes  the  animal  walked  in  circles  towards  the  right ; 
at  times  the  hind  limbs  collapsed,  the  animal  fell  towards  the  left,  and 
had  great  difficulty  in  rising.  The  respiration  was  painful  and  catch- 
ing, the  circulation  slightly  accelerated.  Examination  of  the  head 
revealed  nothing  particular  except  inequality  of  the  pupils,  the  left 
being  larger  than  the  right.  Sensation  was  normal.  Temperature 
39'5°  to  39-8"  C. 

During  the  first  few  days  the  patient  still  ate  a  considerable  portion 
of  her  food.  Twelve  grains  of  iodide  of  potash  were  given  daily.  After 
a  short  time  she  would  only  take  a  few  spoonfuls  of  milk.  She  remained 
lying  quietly  in  her  kennel,  occasionally  lifting  her  head  and  whining. 
Death  occurred  on  the  14th  October. 

Autopsy. — The  lungs  showed  numerous  tumours,  the  majority  the 
size  of  a  hazel-nut,  but  some  as  large  as  a  walnut.  These  were  whitish 
in  colour,  sharply  delimited,  and  consisted  of  a  friable  tissue,  generally 
light  in  colour,  though  reddish  in  places.  Some  contained  a  central 
cavity  filled  with  liquid. 

The  external  appearance  of  the  brain  was  at  first  sight  normal.  On 
more  attentive  examination  a  greyish  area,  which  showed  up  clearly 
against  the  neighbouring  parts,  was  noted  in  the  anterior  half  of  the 
right  hemisphere.  On  incising  this  part  a  little  greyish  liquid  exuded. 
An  ovoid  tumour,  measuring  one  inch  and  a  quarter  from  before  back- 
wards and  three  quarters  of  an  inch  across,  had  developed  in  the  wall 
of  the  hemisphere.  Its  periphery  was  sharply  defined,  and  its  centre 
had  undergone  transformation  into  a  cyst ;  its  tissue  appeared  reddish 
grey. 

No  new  growth  of  any  kind  was  found  in  the  neighbourhood  of  the 
scars  resulting  from  removal  of  the  mammary  tumours. 


TUMOUR   OF    THE    CEREBELLUM.  303 

The  tumours  of  'the  lung  and  brain  showed  the  histological  cha- 
racters of  sarcoma.  They  were  exclusively  formed  of  small  cells,  the 
greater  number  rounded  and  flattened  at  certain  points  by  mutual 
pressure.  All  showed  a  strongly  marked  nucleus  and  vessels  of  em- 
bryonic character, 

TUMOUR    OF    THE    CEREBELLUM. 

4.  Ten-year-old  chestnut  mare,  sent  to  Alfort  on  the  13th  March, 
1897,  by  M.  Laurent,  veterinary  surgeon,  at  Bar-le-Duc. 

History. — The  disease  from  which  this  mare  was  suffering  dated 
from  September,  1896.  It  had  not  developed  in  consequence  of 
violence.  Nothing  noteworthy  was  known  as  to  the  animal's  previous 
history. 

Disturbance  in  movement  was  the  first  symptom  noticed ;  the  gait 
was  irregular,  vacillating,  and  at  certain  times  rolling.  The  animal 
was  unable  to  walk  in  a  straight  line,  but  turned  to  the  right  or  left ; 
movement  was  not  co-ordinated,  the  limbs  were  excessively  extended, 
and  most  frequently  flung  outwards.  At  the  least  excitement  the 
animal  lifted  its  head  high  and  started  back.  If  harnessed  with  ano- 
ther horse  it  could  still  be  used  in  the  carriage.  On  returning  to  the 
stable  it  did  not  appear  unwell,  and  began  to  eat. 

These  first  symptoms  gradually  became  aggravated.  During  the 
later  period  the  animal,  if  approached  in  the  stable,  hung  back, 
appeared  terrified,  rolled  about  on  its  legs,  then  stopped  suddenly, 
with  the  hind  legs  thrust  far  under  the  body.  Left  to  itself  it 
gradually  reassumed  the  normal  position,  lifted  its  head,  and  re- 
mained still.  If  loosened  from  the  manger  and  forced  backwards  it 
pivoted  on  the  hind  legs.  There  was  great  difliculty  in  bringing  it 
out  of  the  stable.  At  first  it  refused  to  walk,  then  it  made  a  few  steps, 
but  seemed  about  to  fall.  During  these  movements  the  head  was 
extended  and  carried  towards  the  right.  Circulation  and  respiration 
were  normal. 

A  blister  was  applied  to  the  vertebral  column  from  the  withers  to 
the  tail  ;  cold  douches  to  the  back  of  the  head  were  prescribed,  and 
sulphate  of  strychnine  was  given  internally. 

The  patient  had  great  difficulty  in  walking  from  the  station  at 
Maisons-Alfort  to  the  College.  Placed  in  a  box  it  lay  down  on  the 
right  side.  Breathing  was  very  rapid  and  difficult.  Motor  power 
appeared  to  be  preserved ;  there  were  frequent  movements  of  the  neck 
and  limbs.  Sensation  was  diminished  :  on  pricking  the  skin  in  different 
parts  of  the  body  no  reaction  resulted.  Temperature  39'7°  C.  The 
animal  was  assisted  into  a  standing  position  and  made  a  few  uncertain 
steps,  but  showed  generalised  trembling  movements  and  soon  fell.  At 
the  end  of  a  few  hours  the  respirations  were  64,  the  pulse  80  per  minute. 
The  conjunctiva  was  cyanotic.     Death  occurred  during  the  night. 

Autopsy. — No  change  could  be  detected  in  the  thoracic  or  abdo- 
minal viscera,  or  in  the  spinal  cord  and  brain,  nor  did  the  exterior  of 
the  cerebellum  show  anything  abnormal.  But  on  incising  the  latter 
we  found  in  the  lower  portion  of  the  vermiform  process,  and  right  lobe 


304  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 

of  the  cerebellum,  a  tumour,  the  size  of  a  small  nut,  developed  particu- 
larly in  the  white  substance,  from  which  it  was  clearly  differentiated  by 
its  greyish  colour  and  firmer  consistence.  Its  right  portion  assisted  in 
forming  the  roof  of  the  fourth  ventricle.  The  growth  had  not  invaded 
the  peduncles  of  the  cerebellum. 

Histologically  examined  after  hardening  in  chromic  acid,  this 
tumour  presented  in  some  respects  the  characters  of  glioma,  but  its 
predominant  features  were  those  of  embryonic  sarcoma. 

TUMOUR    OF    THE    BRAIN     IN    THE    HORSE. 

5.  A  well-nourished  sixteen-year-old  cart-horse. 

History. — Had  always  appeared  nervous.  Six  months  before  death 
was  seen  to  carry  the  head  inclined  towards  the  left  and  the  poll 
towards  the  right,  as  though  the  ear  were  diseased  and  the  animal 
dreaded  it  being  touched.  When  pushed  sharply  away  from  near  side 
appeared  about  to  fall,  and  indeed  did  sometimes  fall.  Had  formerly 
been  used  for  ploughing,  but  was  latterly  unable  to  walk  steadily  in  the 
furrow.  Had  always  been  able  to  back,  though  latterly  had  difficulty 
in  controlling  hind  limbs.  Could  lie  down  and  rise  without  assistance. 
Urine  and  fasces  were  passed  normally.  Appetite  good.  Walked  three 
miles  to  slaughterer's  yard. 

Autopsy  showed  brain  to  be  normal  except  for  presence  of  irregular 
grey  body,  about  the  size  of  half  a  walnut,  between  the  cerebellum  and 
medulla  on  left  side.  This  body  was  partially  blended  with  plexus 
choroides  of  fourth  ventricle,  was  somewhat  soft  and  greasy  in  consist- 
ence, and  seemed  on  microscopic  examination  almost  entirely  formed 
of  crystals  of  cholesterin.  The  cerebellum  and  medulla  were  slightly 
depressed  for  reception  of  the  mass. 

Messrs.  T.  and  W.  Fletcher's  case,  Journ.  Comp.  Path,  and  Therap.,  1891,  p.  261. 

BRAIN    DISEASE— TUMOUR    IN    NEIGHBOURHOOD    OF    CEREBELLUM 

AND    MEDULLA. 

6.  A  Light  Cavalry  horse,  seen  2nd  August,  1886.  No  record  of 
any  previous  brain  disease. 

State  on  Examination. — This  animal  staggered  as  if  drunk,  crossed 
its  legs,  its  eyes  had  a  vacant  stare,  the  extremities  were  cold,  mucous 
membranes  pale,  pulse  rather  small,  46,  respiration  and  temperature 
normal. 

Slight  improvement  during  succeeding  days.  On  the  loth  symptoms 
returned  as  before  ;  the  horse  fell  when  picking  up  some  hay  from  the 
floor,  and  was  lifted  with  difficulty. 

On  the  14th  constant  twitching  of  eyelids  and  hypersesthesia  of 
limbs  ;  no  improvement  followed  administration  of  atropine,  which  was 
substituted  for  strychnine  previously  given. 

By  the  24th  the  animal  had  become  extremely  nervous  and  fright- 
ened at  the  slightest  sound  ;  if  startled  it  would  twitch  and  quiver  all 
over  for  some  minutes,  nearly  falling  in  consequence ;  the  lips  and 
eyelids  continued  to  tremble  markedly  for  a  long  time  afterwards  ;  if 


CEREBRAL    H/EMORRHAGE    IN    THE    HORSE. 


305 


moved  while  limbs  were  trembling,  it  would  blunder  across  its  box,  and 
if  avoiding  a  fall  would  stand  with  the  legs  spread  wide  apart  like  props. 
Course  variable  until  20th  September,  when  aggravation  occurred. 
Killed  on  23rd. 

Autopsy. — Foramen  lacerum  basis  cranii  of  right  side  almost  double 
size  of  left.  Adherent  to  the  pia  mater,  lying  behind  the  cerebellum 
and  between  it  and  the  medulla,  was  an  elongated,  nodular,  firm 
tumour,  constricted  at  its  centre,  and  studded  with  numerous  glistening 
particles  of  cholesterin.  Tumour  bright  red  or  pink  on  section,  and  very 
vascular,  but  showed  no  recent  haemorrhage  and  no  degeneration  or 
calcareous  deposit.  Pia  mater  congested  throughout,  especially 
behind  the  cerebellum.     Brain  normal. 

Veterinary  Captain  Rutherford's  case,  Journ.  Comp.  Path,  and  Therap.,  1893,  p.  72. 


Fig.  23. — Position  at  rest. 

CEREBRAL    HEMORRHAGE    IN    THE    HORSE. 

7.  Eleven-year-old  bay  gelding,  i6"3  hands,  seen  February  5th,  1896. 

History. — Had  shown  "  staggers  "  on  day  previous  to  examination, 

and  been  taken  home.     The  head  was  carried  to  one  side  (see  Fig.  23)  • 


3o6 


CLINICAL   VETERINARY    MEDICINE    AND    SURGERY. 


the  animal  seemed  weak  in  its  hind  quarters,  and  threatened  to  fall  if 
urged  beyond  a  slow  walk. 

State  on  Examination. — Pulse  36,  respiration  16,  temperature  ioo-i-°  F. 
The  neck  was  turned  to  the  right  side,  it  rotated  on  the  head,  and 
the  chin  was  directed  towards  the  middle  line.  Slight  paralysis  of 
muscles  of  right  side ;  lip  and  nose  turned  towards  the  right ;  right 
nostril  more  dilated  than  left,  especially  when  horse  was  excited.  The 
skin  of  right  nostril  was  more  sensitive  to  pin  pricks  than  that  of 
left.  The  right  eye  was  turned  downwards,  inwards,  and  forwards, 
was  sensitive  to  light,  and  the  fundus  appeared  normal.  The  left  was 
turned  upwards  and  outwards,  the  cornea  appeared  unduly  convex 
and  the  whole  eye  prominent,  the  pupil  was  widely  dilated,  the  retina 
was  insensitive  to  light,  the  eye  was  immoveable  and  did  not  follow 
the  light,  and  the  membrana  nictitans  projected  some  distance  over  it. 
There  was  slight  ptosis.  The  eyes  were  held  in  asymmetrical  posi- 
tions ;  the  right  seemed  less  under  control  than  the  left.     Slight  noises 


Fig.  24. — Brain  seen  from  left  side.     Cerebellar  tumour  shown  lighter  shaded. 


seemed  more  alarming  on  left  than  on  right  side.  The  left  ear  was 
moved  freely. 

The  hind  limbs  were  moved  with  difficulty,  the  toes  dragging  along 
the  ground;  when  turning  the  horse  almost  fell  down.  Noises,  etc., 
especially  on  the  left  side,  greatly  aggravated  the  symptoms.  The  neck 
was  then  jerked  away  to  the  right,  the  head  twisted  on  the  neck  until 
its  sides  were  almost  horizontal,  the  squinting  increased,  and  the  animal 
staggered,  lifted  and  put  down  its  feet  spasmodically,  and  seemed  about 
to  fall. 

Diagnosis. — Brain  lesion.  On  account  of  sudden  onset  and  extensive 
area  involved  is  apparently  due  to  haemorrhage ;  the  symptoms  shown 
point  to  injury  in  the  fourth  ventricle,  slightly  to  one  side  of  middle 
line  and  almost  directly  over  corpora  quadrigemina. 

Improvement  was  slow,  and  owing  to  the  uncertainty  of  cure  the 
animal  was  destroyed  by  intra-tracheal  injection  of  one  ounce  of  prussic 
acid.     Death  only  occurred  after  seven  or  eight  minutes. 

Autopsy  showed  no  important  lesions  in  the  thorax  or  abdomen. 


CEREBRAL    INJURY    AND    CHEYNE-STOKES    RESPIRATION    IN    A    HORSE. 


307 


On  examining  the  brain  a  tumour  the  size  of  a  hen's  egg  was  found  on 
the  left  lobe  of  the  cerebellum  (see  Fig.  24),  extending  from  the  extreme 
outer  margin  of  the  left  lobe  to  a  point  considerably  beyond  the  middle 
line.  It  resembled  in  shape  a  peg-top ;  the  point  was  thrust  under  the 
right  lobe  of  the  cerebellum  ;  the  body  had  replaced  a  large  part  of  the 
left  lobe  of  the  cerebellum.  In  substance  it  was  moderately  firm, 
nodulated  and  encapsuled.  Microscopical  examination  showed  it  to 
be  a  glioma.  On  cutting  through  the  central  line  of  the  cerebellum 
a  small  haemorrhage  was  found  at  the  base  above  the  fourth  ventricle. 
On  dividing  the  brain  by  successive  slices  another  haemorrhage  was 


sUi.  s^XtxiWrfe^e. 


c^A^'3. 


Fig.  25. — Vertical  section  through  brain  about  half  an  inch  to  the  right  of 
the  middle  line. 

found  at  the  point  indicated  in  the  figure,  about  half  an  inch  from  the 
median  commissure  and  in  the  right  side.  Haemorrhage  was  slight, 
but  the  brain  showed  many  small  pink  spots  in  this  neighbourhood. 

Note. — The  inability  to  co-ordinate  movement  was  probably  due  to 
the  haemorrhage  at  the  base  of  the  cerebellum,  the  facial  lesions  to  the 
cerebral  haemorrhage.  The  part  played  by  the  tumour  appeared  to  be 
secondary,  as  the  growth  had  existed  for  a  long  time  previously  without 
producing  symptoms. 

Mr.  Jno.  A.  W.  Dollar's  case,  Veterinarian,  1896,  p.  393. 

CEREBRAL    INJURY    AND    CHEYNE-STOKES    RESPIRATION     IN 

A    HORSE. 

8.  A  four-year-old  brown  gelding. 

History. — When  hunting,  came  down  at  a  fence  and  pitched  on  its 
head  ;  for  the  rest  of  the  day  it  did  not  jump  as  well  as  usual.  Coming 
home  its  action  seemed  exaggerated,  the  fore-legs  being  thrown  out- 
wards. It  stopped  as  though  to  stale,  but  did  not  succeed  ;  it  then 
seemed  to  stagger  and  go  wide  behind.  From  this  time  it  was  led. 
On  arrival  in  the  stable  it  was  amaurotic,  and  stood  with  the  head 
against  the  wall. 

State  on  Examination. — Seemed  in  some  abdominal  pain  ;  lay  on  the 


3o8  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

near  side,  bathed  in  perspiration,  and  struggled  violently  and  inces- 
santly. The  pupil  was  dilated,  pulse  about  60.  No  hardness  of  gluteal 
muscles.  One  hour  after  hypodermic  injection  of  morphia  was 
sufficiently  quiet  for  the  catheter  to  be  passed ;  urine  moderate  in 
quantity  and  normal  in  colour. 

Diagnosis. — Brain  injury,  due  either  to  fracture  or  blood-clot. 

Two  hours  after  first  examination  the  breathing  began  to  assume 
the  Cheyne-Stokes  character  ;  for  about  twelve  seconds  respiration  was 
suspended,  the  pulse  meanwhile  becoming  slower  and  weaker,  all 
movements  of  limbs  suspended,  and  the  animal  appearing  in  a  deep 
sleep  ;  pulse  about  70.  This  interval  was  followed  by  a  feeble  inspira- 
tion, followed  by  others  of  increasingly  greater  force,  the  sixth  being 
the  deepest  and  most  marked.  With  each  the  pulse  increased  in 
frequency  and  force,  as  did  movements  of  the  limbs.  The  third  period 
was  marked  by  decline  in  amplitude  of  respirations  until  the  sixth, 
which  was  almost  imperceptible ;  the  pulse  decreased  in  strength,  the 
number  falling  to  70,  and  all  movements  gradually  ceasing.  The  second 
and  third  periods  occupied  twelve  seconds. 

The  number  of  respirations  in  each  period  afterwards  lessened, 
though  still  occupying  the  same  time.  The  apnoeal  periods  increased 
in  duration  to  nearly  twenty  seconds.  Movement  of  the  fore-limb 
ceased,  and  the  hind  limb  moved  but  slightly. 

Six  and  a  half  hours  after  first  examination  the  respiration  assumed 
the  form  of  a  single  deep  gasp,  followed  by  a  deep  expiration  and  one 
or  more  shallow  movements  with  a  long  apnoeal  period.  Death 
occurred  seven  hours  after  first  examination. 

Post-mortem  Examination. — All  internal  organs  healthy ;  some 
bruising  on  the  frontal  bone.  A  large  blood-clot  at  the  base  of  the 
medulla,  on  the  right  side,  just  over  origin  of  the  pneumogastric  nerve. 
The  whole  of  the  pia  mater  was  much  injected. 

Mr.  V.  W.  Evans'  case,  Joiirn.  Coinp.  Path,  and  TJierap.,  1895,  p.  83- 

TUMOUR    OF    THE    VERTEBRAL    COLUMN. 

9.  Nine-year-old  sheep-dog.  Entered  hospital  on  the  17th  May, 
1894. 

A  fortnight  previously  this  dog,  whose  health  had  always  been  good, 
showed  difficulty  in  walking,  especially  in  moving  the  hind  limbs,  a 
difficulty  which  rapidly  increased.  One  morning  the  animal  was  found 
paralysed  in  the  hind  limbs. 

State  on  Examination. — Paralysis  of  the  hind  limbs  was  complete. 
If  the  animal  was  forced  to  move  the  legs  were  dragged  along  the 
ground.  Sensation  was  not  abolished,  pricks  with  a  pin  causing 
struggling.  Respiration  and  circulation  were  normal,  appetite  was 
good,  and  no  difficulty  in  defecation  or  micturition  had  been  noted. 
Temperature  37*8°  C. 

Rectal  exploration  threw  no  light  on  the  case,  and,  in  fact,  nothing 
could  be  detected  to  account  for  the  paralysis. 

Treatment  consisted  in  administering  iodide  of  potassium  in  doses 
of  15  to  30  grains  per  day.  Milk  diet.  No  improvement.  Death 
occurred  on  the  31st  May. 


CANCER    OF    THE    LOWER    EYELID    AND    GLOBE    OF    THE    EYE. 


309 


Autopsy. — On  the  body  of  the  first  lumbar  vertebra  was  found  a  hard 
spherical  tumour,  the  size  of  an  egg,  measuring  two  and  a  quarter 
inches  from  before  backwards,  and  two  inches  across.  It  chiefly  occu- 
pied the  right  part  of  the  vertebra,  the  transverse  process  of  which  it 
entirely  surrounded,  and  was  formed  of  two  lobes,  one  developed  on  the 
right  surface  of  the  body  of  the  vertebra,  the  other  (which  covered  the 
inferior  surface  from  one  transverse  process  to  the  other)  extended 
beyond  the  left  transverse  process,  above  which  on  the  vertebra  a  large 
osteophyte  was  visible.  The  upper  lobe  of  this  tumour  was  in  contact 
with  the  last  dorsal  vertebra,  which  it  had  thrust  backward  and  some- 
what to  one  side.  Its  low^er  lobe  covered  a  portion  of  the  lower 
surface  of  the  second  lumbar  vertebra. 

On  exposing  the  spinal  cord  in  the  lumbo-sacral  region  the  cha- 


FiG.  26. — Sarcoma  of  the  vertebral  column. 

racters  and  relationships  of  the  tumour  could  be  clearly  made  out.  It 
formed  in  the  spinal  canal  a  distinctly  marked  prominence  about  one 
and  a  quarter  inches  in  length,  above  which  the  spinal  cord  was  com- 
pressed and  reduced  to  half  its  normal  thickness.  Its  consistence 
varied  according  to  the  point  chosen  :  the  part  within  the  neural  canal 
was  relatively  soft,  yielded  to  pressure,  and  was  easily  divided  with  the 
point  of  the  bistoury,  but  towards  the  centre  the  appearances  were 
those  of  bony  tissue. 

On  microscopic  examination  the  tumour  appeared  formed  _  of 
fusiform  cells  and  tracts  of  osteoid  tissue,  pierced  with  branching 
cavities  provided  with  canaliculi,  and  offering  the  appearance  of  osteo- 
blasts. 


B.—EYE    AND    EAR. 


CANCER  OF  THE  LOWER  EYELID  AND  GLOBE  OF  THE  EYE.  . 

10.  Eleven-year-old  gelding.  Entered  hospital  on  the  i8th  July, 
1898.  Four  months  before  the  eyelids  of  the  right  eye  were  found  to 
be  glued  together  each  morning  by  muco-pus.  A  veterinary  surgeon 
who  was  consulted  thought  this  due  to  simple  conjunctivitis,  and 
prescribed  boric  acid  lotions.  The  discharge  continued,  the  lower 
eyelid  became  thickened,  vegetations  developed  on  the  conjunctiva, 
thrusting  aside  the  eyelid  and  soon  extending  beyond  the  free  margin . 


3IO  CLINICAL   VETERINARY   MEDICINE   AND    SURGERY. 

The  patient  was  first  brought  for  examination  in  June,  and  was 
then  regarded  as  suffering  from  granular  conjunctivitis.  The  vegeta- 
tions were  removed  with  scissors,  and  the  parts  curetted.  At  this  time 
the  eye  was  still  intact.  A  i  per  2000  sublimate  solution  was  prescribed 
as  a  collyrium. 

The  parts  did  not  heal.  Further  vegetations  developed  and  rapidly 
increased  in  size. 

When  the  horse  was  left  in  hospital  a  reddish,  flattened,  trans- 
versely elongated  tumour,  somewhat  resembling  a  strawberry,  projected 
from  between  the  eyelids.  The  upper  lid  remained  soft  and  moveable ; 
the  lower,  from  which  the  tumour  sprang,  was  everted.  The  globe  of 
the  eye  was  partly  covered  by  the  new  growth,  and  to  some  extent 
pushed  back  into  its  cavity.  The  right  side  of  the  face  was  denuded 
of  hair,  and  soiled  by  a  purulent  discharge. 

Operation.  — Once  the  animal  was  cast  it  was  discovered  that  the 
tumour  had  invaded  the  globe  of  the  eye.  The  cornea  was  opaque 
and  perforated  at  two  points.  It  therefore  became  necessary  to  remove 
the  whole  of  the  eye  and  a  part  of  the  lower  eyelid,  preserving  as  far 
as  possible  the  skin  covering  the  latter. 

The  orbital  cavity  was  cleared  out  and  filled  with  gauze,  and  the 
eyelids  were  brought  together  with  three  sutures.  This  dressing  was 
removed  next  day,  and  treatment  was  afterwards  confined  to  antiseptic 
injections. 

The  tumour  was  the  size  of  a  walnut,  elongated  in  its  transverse 
diameter,  slightly  flattened,  rounded  on  the  surface,  and  of  firm  con- 
sistence. The  surface  of  sections  appeared  dry,  but  pressure  caused 
filaments  or  little  grains  to  exude,  which  were  exclusively  formed  of 
epithelial  cells. 

The  histological  appearance  of  the  tumour  showed  it  to  be  an 
epithelioma  of  the  pavement  epithelium  type.  It  was  formed  of  a 
connective-tissue  stroma  and  of  epithelial  cells  disposed  in  lobules, 
which  were  massed  closely  together  or  united  by  tracts  of  the  same 
character. 

The  animal  left  on  the  ist  March,  but  was  brought  back  two  months 
later  for  the  application  of  an  artificial  eye  of  hardened  india  rubber. 
The  tumour  did  not  return. 


MALIGNANT    CARCINOMATOUS    INTRA-ORBITAL    GROWTH    WITH 
DESTRUCTION    OF    THE    EYE    IN    A    COW. 

II.  A  well-bred  shorthorn  cow;  first  seen  March  20th,  1893. 

History. — Two  years  before  the  animal  had  suffered  from  ''  chaff  in 
the  eye,"  followed  by  a  cold.     Nothing  was  done. 

State  on  Examination. — The  right  eye  was  totally  destroyed  and  its 
place  occupied  by  a  fungoid  mass,  which  protruded  two  inches  beyond 
the  palpebral  fissure.  The  surface  of  this  mass  was  covered  by  a  scab, 
on  removing  which  the  tumour  appeared  formed  of  broken-down  tissue 
and  new  capillary  vessels. 

Despite  antiseptic  treatment  the  growth  continued,  and  attained 
enormous  dimensions.     In  June  it  was  removed,  and  the  wound  dressed 


TRAUMATIC    CATARACT.  3II 

with  saturated  solution  of  zinc  sulphate.  Improvement  was  only  tem- 
porary ;  in  a  few  weeks  the  ej^elids  and  surrounding  subcutaneous  tissue 
became  involved.  During  the  succeeding  weeks  masses  of  extremely 
foetid  new  growth  were  several  times  removed.  Owing  to  continued 
spread  of  the  growth  the  animal  was  at  length  killed. 

Autopsy. — The  orbit  was  occupied  by  a  foul,  stinking  mass  of  broken- 
up  tissue  of  a  dirty  brown  colour,  the  eyelids  were  enormously  thick- 
ened, and  the  eyelashes  replaced  by  a  border  of  cicatricial  tissue. 
The  extruding  mass  measured  five  and  a  half  inches  in  diameter,  and 
the  surrounding  swelling  about  nine  inches.  Beneath  the  skin  was  a 
layer  several  inches  thick  of  repulsively  smelling  necrosed  new  growth, 
presenting  the  characters  of  carcinoma.  The  cranial  bones  were 
absolutely  healthy ;  the  growth  appeared  to  have  originated  either  in 
the  eyeball  itself  or  from  the  peri-orbitale. 

No  visceral  metastasis  or  septic  infection  was  noted  on  post-mortem, 
and  the  cow's  continued  good  health  until  a  fortnight  before  slaughter 
contra-indicated  such  a  condition. 

Microscopical  examination  confirmed  the  diagnosis  of  carcinoma. 

Mr.  Breakall's  case,  described  by  Prof.  McFadyean,  Joitrn.  Cotnp.  Path.  a7jd  Therap., 
1893,  p.  365. 

TRAUMATIC    CATARACT. 

12.  Four-year-old  English  terrier.  Brought  for  examination  on  the 
29th  July,  1897. 

Two  days  before  this  animal  while  playing  had  torn  the  right  eye 
on  a  piece  of  iron  wire  projecting  from  a  grating.  The  wound  was 
treated  with  dilute  acetate  of  lead  lotion. 

At  the  time  of  our  examination  the  eye  was  closed,  weeping,  and 
very  sensitive.  After  applying  cocaine  we  were  able  to  estimate  the 
gravity  of  the  injury.  The  cornea  was  perforated  a  little  below  its 
centre  by  a  narrow  opening,  from  which  escaped  aqueous  humour. 
The  margins  of  this  opening  were  fairly  regular,  and  slightly  swollen. 
In  the  lower  portion  of  the  anterior  chamber  was  a  reddish  haemor- 
rhagic  deposit,  but  no  foreign  body  was  present. 

Treatment. — Careful  disinfection  of  the  cornea,  conjunctiva,  and 
eyelids  by  warm  creolin  solutions,  and  frequent  instillation  into  the 
eye  of  a  warm  solution  composed  as  follows  : 

Creolin  .         .         .         .         •     5°  minims. 
Boiled  water  .         .         .         .       i  pint. 

The  patient  was  brought  back  each  week.  The  extravasated  blood 
in  the  anterior  chamber  gradually  became  reabsorbed.  In  spite  of 
considerable  granulation  around  the  margins  of  the  perforation  in  the 
cornea  healing  occurred  rapidly,  and  without  acute  complications. 
The  opacity  of  the  cornea  and  wound  gradually  diminished,  and  finally 
completely  disappeared  ;  but,  in  proportion  as  the  cornea  grew  clearer, 
we  were  able  to  detect  another  change  in  the  deeper  portion  of  the 
eye,  viz.  the  formation  of  a  cataract.  This  change  proceeded  rapidly. 
Three  months  after  its  appearance  vision  on  this  side  was  destroyed. 

By  the  following  May  there  only  remained  a  very  trifling  depression 


312  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

in  the  cornea,  and  even  here  the  parts  were  as  transparent  as  other 
portions  of  the  eye. 

CATARACT— OPERATION. 

13.  Six-year-old  poodle  affected  with  double  cataract.  Left  in 
hospital  i6th  April,  i8g8. 

The  first  signs  of  disease  in  the  eye  had  occurred  two  years  before. 
The  lens  of  each  eye  gradually  became  opaque,  though  that  of  the 
left  eye  was  more  rapidly  affected  than  the  right. 

State  on  Entry. — The  lens  of  the  left  eye  was  completely  opaque. 
On  the  whitish  ground  formed  by  the  lens  a  few  striae,  arranged  in  the 
shape  of  a  star,  could  be  seen,  and  towards  the  centre  several  little 
greyish  spots.  The  right  lens  was  opaque  throughout,  but  the  opacity 
was  a  little  less  marked  and  more  uniform  than  in  the  left  lens. 

Vision  was  completely  abolished.  In  unfamiliar  spots  the  animal 
continually  ran  against  obstacles. 

Treatment. — We  were  asked  to  operate,  and  decided  to  deal  first 
with  the  left  eye.  For  three  days  the  eye  was  prepared  by  bathing 
with  warm  solutions  of  3  per  cent,  boric  acid,  and  with  i  in  3000 
sublimate. 

On  the  19th  the  animal  was  anaesthetised  with  atropomorphine 
and  chloroform.  The  operation  chosen  was  that  in  which  the  lens  is 
depressed,  and  was  performed  by  the  usual  method.  Trifling  haemor- 
rhage occurred  under  the  conjunctiva  at  the  point  of  puncture,  and  a 
little  blood  also  passed  into  the  anterior  chamber  of  the  eye.  During 
the  night  the  eye  was  several  times  fomented  with  wadding  saturated 
in  warm  boric  solution.  The  animal's  kennel  was  covered  so  as  to 
keep  it  in  semi-darkness.  The  patient  readily  took  milk  and  a  little 
meat. 

The  same  treatment  was  continued  during  the  following  days  : 
a  little  opacity  appeared  in  the  anterior  chamber,  but  in  a  week  it  had 
entirely  disappeared,  together  with  the  effused  blood  and  the  ecchy- 
mosis  under  the  conjunctiva.  Even  at  this  stage  there  was  marked 
improvement.  The  dog  saw  sufficiently  to  choose  its  path  and  avoid 
obstacles.  It  had  no  difficulty  or  hesitation  in  entering  its  kennel, 
whilst  previous  to  operation  it  always  struck  against  the  step  in 
front. 

Remark. — The  observations  of  Berlin,  Moller,  Randolph,  and 
Contejean  show  that  in  the  dog  accommodation  is  soon  restored.  In 
practice  it  is  well  to  restrict  operation  to  discission  for  soft  cataracts, 
and  to  depression  for  others.  Without  doubt  these  methods  are  very 
inferior  to  extraction,  but  they  have  the  double  advantage  of  being 
less  dangerous  and  capable  of  performance  by  most  practitioners. 

SYMBIOTIC    ACARIASIS    AND    ECZEMA    OF    THE    EAR. 

14.  Six-year-old  Havanese  bitch,  entered  hospital  30th  December, 
1898. 

History. — During  April,  1898,  this  bitch,  which  lived  in  its  owner's 
rooms,  suddenly  presented  a  concourse  of  symptoms  apparently  due  to 


SYMBIOTIC    ACARIASIS    AND    ECZEMA    OF    THE    EAR.  3x3 

some  nervous  affection.  In  addition  to  restlessness,  loss  of  appetite, 
and  depression,  it  showed  at  varying  intervals  paroxysms  of  trembling 
and  slight  rigidity  of  the  body  muscles. 

These  symptoms  gradually  became  more  marked.  One  morning 
the  .patient  was  seen  to  turn  in  circles  to  the  right,  the  head  inclined 
towards  the  same  side  and  slightly  depressed. 

A  specialist  who  was  consulted  regarded  the  symptoms  as  due  to  a 
brain  lesion.  He  prescribed  friction  with  antimonial  ointment  over 
the  upper  part  of  the  neck  and  base  of  the  brain.  This  treatment 
giving  no  result  he  passed  a  seton  behind  the  head.  In  spite  of  the 
suppuration  produced  by  leaving  the  seton  in  position  for  a  month  the 
disturbance  persisted. 

Towards  the  end  of  August  the  animal  one  evening  had  an 
epileptiform  attack,  the  head  being  markedly  turned  towards  the 
right,  and  the  animal  falling  on  the  same  side. 

Three  weeks  before  entering  hospital  it  had  another  more  violent 
attack,  and  again  fell  on  the  right  side.  Bromide  of  potassium  was 
prescribed.  On  the  29th  December  a  further  epileptiform  attack 
occurred  similar  to  the  preceding.  On  the  evening  of  the  next  day 
the  bitch  was  sent  to  the  School. 

State  on  Examination. — The  patient  held  the  head  inclined  towards 
the  right  side,  was  depressed,  and  took  no  notice  of  what  passed  around 
it.  Although  it  had  suffered  from  these  attacks  for  several  months  it 
was  still  in  fairly  good  condition.  There  was  no  rigidity  of  muscle  and 
no  interference  with  movement.  At  times  the  animal  shook  its  ears 
and  scratched  them  with  the  hind  limbs.  It  had  scarcely  been  placed 
in  a  kennel  before  it  was  taken  with  a  fit.  It  fell  forwards,  the  head 
being  turned  towards  the  right  side,  its  long  axis  inclined  downwards 
and  towards  the  left,  the  right  temporo-auricular  region  resting  on  the 
straw  ;  howled  loudly,  and  made  convulsive  circular  movements  from 
left  to  right  around  the  head,  which  acted  as  a  pivot.  This  attack 
lasted  for  three  minutes.  The  animal  rose,  remained  stupid  for  a  few 
moments,  and  then  resumed  its  former  appearance. 

During  the  night  it  ate  some  fragments  of  meat  given  by  hand. 
Five  minutes  later  it  was  seized  with  nausea  and  vomiting  attacks. 

At  next  day's  visit  I  made  inquiries  as  to  the  animal's  history. 
Examining  the  interior  of  the  ears  I  noted  at  the  entrance  to  the 
auditory  meatus  an  abundant  deposit  of  brownish  wax,  which  I  directed 
to  be  microscopically  examined,  with  the  result  that  it  was  found  to 
contain  numerous  symbiotes  (Symbiotes  ecaudatus,  var.  canis). 

Treatment. — Washing  out  of  the  ears  with  soap,  cleansing  of  the 
external  meatus,  drying  with  wadding,  injection  of  i  per  cent,  solution 
of  sulphide  of  potash,  and  light  friction  around  the  base  of  the  ear,  so 
as  to  favour  the  penetration  of  the  liquid,  drying  of  the  entrance  to  the 
meatus  and  application  of  a  few  drops  of  balsam  of  Peru.  The  injection 
of  sulphide  of  potash  solution  and  the  after  application  of  Peruvian 
balsam  were  repeated  every  day  until  the  15th  January. 

On  the  6th  the  patient  was  less  depressed ;  it  took  a  little  nourish- 
ment. The  inner  surface  of  the  fore-limbs  showed  an  eczematous 
eruption,  accompanied  by  severe  itching.     After  clipping  away  the  hair 


314  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

the  diseased  skin  was  disinfected  with  warm  creoHn  solution  and 
powdered  with  starch. 

On  the  8th  the  disturbance  due  to  the  acari  was  markedly  dimin- 
ished, but  the  two  eczematous  patches  on  the  inner  surface  of  the  fore- 
limbs  were  transformed  into  wounds,  which  the  animal  incessantly- 
licked  and  gnawed.  The  discharging  surfaces  were  disinfected  and  a 
cotton-wool  dressing  applied,  covering  the  limbs  as  high  as  the 
shoulder. 

Next  morning  the  dressings  were  found  torn.  Fresh  ones  were 
applied,  which  were  left  undisturbed  for  three  days,  when  they  were 
renewed. 

After  the  15th  the  animal  showed  no  further  epileptiform  symptoms 
nor  digestive  trouble. 

On  the  20th  the  wound  on  the  left  leg  was  dry ;  a  portion  of  that 
on  the  right  was  still  moist,  but  by  the  27th  it  had  healed. 

On  the  3rd  February  the  animal  was  cured  both  of  the  acariasis  and 
of  the  eczema. 

Remark. — Acariasis  of  the  ear — the  pseudo-epilepsy  seen  in  packs — 
occurs  with  some  frequency  in  dogs  kept  in  living  rooms.  Seldom  a 
year  passes  without  our  seeing  cases.  In  that  just  described  the  method 
of  contagion  remained  doubtful.  According  to  the  owner's  statement 
the  animal  was  very  carefully  looked  after  and  never  came  near  other 
dogs. 

C.—A^OSE    AND    NASAL    CAVITIES. 
NECROSIS    OF    THE    NASAL    SEPTUM. 

15.  Seven-year-old  entire  horse.  Entered  hospital  29th  October, 
1894. 

Two  months  before  the  animal  had  received  a  kick  on  the  forehead. 
The  part  became  swollen,  respiration  difficult  and  noisy,  and  discharge 
occurred  from  both  nostrils. 

State  on  Entry. — The  passage  of  air  through  the  nose  was  obstructed  ; 
even  at  a  distance  a  roaring  sound  could  be  heard.  The  face  was 
deformed  ;  over  the  lower  portion  of  the  nasal  bones,  and  extending  as 
far  as  their  extremity,  was  a  swelling  which  was  painful  on  pressure  and 
equally  marked  on  either  side  of  the  median  line.  Both  nostrils 
discharged  a  little  purulent  liquid.  On  the  septum,  near  the  entrance 
to  the  nasal  cavities,  and  on  either  side,  was  a  narrow  wound  with 
hardened  reddish  margins,  forming  the  entrance  to  a  sinus  about  three 
inches  deep.  Higher  up — towards  the  roof  of  the  cavity  and  on  the 
septum. — could  be  distinguished  an  oval  prominence,  elongated  in  the 
direction  of  the  long  axis  of  the  head,  formed  b}'  separation  of  the 
mucous  membrane  from  the  subjacent  tissues.  Pressure  with  the  finger 
caused  a  discharge  of  greyish  pus  from  the  sinus.  The  submaxillary 
glands  were  swollen  and  hard,  the  condition  being  rather  more  marked 
on  the  right  than  on  the  left  side. 

Diagnosis. — Partial  necrosis  of  the  nasal  septum.  As  the  animal 
was  useless  for  work,  on  account  of  the  difficulty  in  breathing,  we  were 
asked  to  perform  tracheotomy. 


NECROSIS    OF    THE    CARTILAGE    OF    THE    LEFT    NOSTRIL.  315 

Treatment. — The  nasal  bone  was  trephined  over  the  most  prominent 
portion  of  the  swelhng  and  along  the  median  line,  disclosing  a  fragment 
of  necrotic  tissue  on  the  cartilaginous  septum.  The  opening  was 
enlarged,  the  edges  rounded  off,  and  the  necrosed  cartilage  removed  by 
curetting.  The  wound  thus  produced  was  washed  out  with  carbolic 
solution,  and  its  margins  touched  with  tincture  of  iodine.  A  gauze 
drain  was  passed  into  each  of  the  nasal  cavities. 

During  the  next  few  days  the  wound  was  cleansed  night  and  morning 
with  I  per  cent,  creolin  solution,  and  the  drains  occasionally  renewed. 

Treatment  ceased  on  the  ist  December.  The  animal  returned  to 
work.  Cure  became  complete  after  a  time.  Respiration  was  only 
slightly  interfered  with,  the  diminution  in  size  of  the  nasal  cavities 
opposite  the  old  necrotic  centre  being  trifling. 

NECROSIS    OF    THE    CARTILAGE    OF    THE    LEFT    NOSTRIL. 

16.  A  nine-year-old  gelding  brought  for  examination  on  the  20th 
October,  1895,  with  the  following  history :  About  two  months  ago  the 
animal,  while  in  the  same  stable,  had  been  bitten  on  the  nose  by 
another  horse.     Treated  with   carbolic  lotion   the   cutaneous  wound 


Fig.  27. —  Necrosis  of  tfie  nasal  cartilage. 

healed  rapidlj-,  but  the  inner  part  of  the  nose  became  swollen  and  a 
more  or  less  abundant  discharge  continued. 

State  on  Examination  — A  little  purulent  discharge  ran  from  the 
lower  portion  of  the  left  nostril.  The  inner  wing  of  the  nostril 
throughout  its  entire  extent — but  especially  towards  its  upper  part — 


3l6  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

was  swollen  and  indurated.  On  examining  the  nasal  cavity  the  swell- 
ing was  seen  to  be  limited  to  the  anterior  portion,  that  is  the  part 
corresponding  to  the  cartilaginous  plate.  The  skin  covering  this,  and 
a  narrow  layer  of  the  pituitary  membrane,  were  swollen,  thickened, 
and  somewhat  prominent.  At  the  margin  between  the  middle  and 
upper  thirds  of  the  upper  wing  of  the  nostril  appeared  a  fungous, 
reddish,  soft  mass  of  granulations,  from  which  pus  discharged  when 
the  lower  part  of  the  swollen  nostril  was  pressed  with  the  finger. 
The  left  submaxillary  gland  contained  a  somewhat  hard  swelling  the 
size  of  a  small  nut,  moveable  under  the  skin,  but  adherent  to  the 
deeper  seated  tissues.  In  the  right  nasal  cavity  the  pituitary  mem- 
brane was  neither  swollen  nor  injected,  and  the  internal  wing  of  the 
nostril  was  of  normal  flexibility. 

Having  cast  the  animal  on  the  right  side  probing  revealed  the 
presence  under  the  granulations  of  an  open  sinus  about  one  and  a 
quarter  inches  in  depth,  running  obliquely  downwards  and  inwards. 
This  sinus  was  laid  open  throughout  its  entire  extent,  and  the  walls 
swabbed  with  tincture  of  iodine,  by  means  of  a  probe  covered  with 
wadding. 

The  patient,  which  continued  to  work,  was  only  dressed  very 
irregularly.  In  consequence  it  became  necessary  to  expose  the  parts  a 
second  time.  The  swelling  of  the  nostril  and  suppuration  greatly 
diminished,  but  recovery  was  not  complete  until  after  four  months. 

Remarks. — Necrosis  of  the  nasal  cartilage  marked  by  muco-purulent 
discharge  and  enlargement  of  the  submaxillary  gland  of  the  correspond- 
ing side,  may  at  first  awaken  suspicion  of  glanders.  Differential 
diagnosis,  however,  is  easy  without  recourse  to  mallein.  On  examining 
the  nasal  cavity  the  inner  wing  of  the  nostril  shows  a  hard,  circum- 
scribed swelling,  which  usually  occupies  the  entire  extent  of  the  wing ; 
and  a  fistula,  whence  on  pressure  over  the  swollen  area  greyish,  ill- 
formed  pus,  sometimes  streaked  with  blood,  escapes.  The  swollen 
parts  are  often  rough,  prominent,  or  folded.  Fig.  27  shows  the 
appearances  in  a  case  brought  for  examination  during  September  last 
as  suspected  of  glanders.  The  inner  wing  of  the  right  nostril  showed 
throughout  its  entire  extent  a  considerable,  sharply  circumscribed, 
rounded  swelling,  most  extensive  below,  where  it  was  irregular  and 
exhibited  several  narrow  folds.  From  its  posterior  border  projected  a 
mass  of  soft,  bleeding  granulations,  which  masked  the  sinuous  tract. 

SEBACEOUS    CYSTS    IN    THE    FALSE    NOSTRILS. 

17.  A  seven-year-old  mare,  left  in  hospital  ist  February,  1898. 

Was  suffering  from  sebaceous  cysts  of  the  false  nostrils,  which  first 
appeared  several  years  before.  By  their  progressive  growth  these 
tumours  had  finally  interfered  with  breathing ;  the  mare  soon  lost 
breath,  and  made  a  snorting  noise  during  work.  In  September,  1897, 
the  swellings  were  punctured,  their  contents  evacuated,  and  the  interior 
washed  with  an  antiseptic  solution,  but  they  soon  formed  again. 

On  entering  hospital  this  mare  showed  in  each  false  nostril,  an  inch 
or  two  from  the  external  opening  of  the  nose,  a  spherical,  yielding. 


CHRONIC  INFLAMMATION  AND  NECROSIS  OF  POSTERIOR  TURBINATED  BONE.    317 

non-fluctuating,  cool,  painless  swelling  ;  the  right  was   rather  larger 
than  the  left  and  the  size  of  a  hen's  egg. 

On  the  2nd  February,  after  washing  and  disinfecting  the  skin  the 
cysts  were  punctured  with  a  trocar,  giving  exit  to  a  greyish,  thick, 
granular  material.  The  cavities  were  injected  with  pure  tincture  of 
iodine,  and  after  manipulation  the  excess  of  injected  fluid  was  removed. 
On  the  following  days  the  parts  showed  inflammatory  swelling,  par- 
ticularly on  the  left  side.  On  the  15th  February  the  left  cyst  had 
almost  completely  disappeared,  but  the  right  had  resumed  its  former 
dimensions.     Ablation  was  therefore  decided  on. 

On  the  i8th  February  the  mare  was  cast  on  Daviau's  table.  The 
parts  having  been  prepared,  two  curved  incisions  were  made  enclosing 
an  elliptical  piece  of  skin,  three  quarters  of  an  inch  wide  at  the  centre, 
which  was  removed,  together  with  the  w^all  of  the  C3'st.  The  deep 
portion  of  the  latter  had  to  be  left,  dissection  being  a  delicate  matter, 
and  the  animal  struggling  violently.  The  interior  was  swabbed  out 
with  a  tampon  saturated  with  10  per  cent,  chloride  of  zinc  solution. 
The  margins  of  the  wound  were  brought  together  over  a  drainage-tube. 
During  the  following  days  weak  warm  carbolic  solution  was  injected. 

On  the  sixth  day  the  drainage-tube  was  removed,  and  the  parts 
treated  as  an  open  wound.  A  week  later  complete  healing  had 
occurred. 

CHRONIC    INFLAMMATION    AND    NECROSIS    OF    THE    POSTERIOR 
(MAXILLARY)    TURBINATED    BONE. 

18.  Four-year-old  mare,  sufl"ering  from  a  tumour  of  the  left  nasal 
cavity. 

History. — Seven  or  eight  months  ago  the  left  side  of  the  animal's 
face  showed  a  swelling,  which  gradually  increased ;  discharge  occurred 
from  the  left  nostril ;  some  time  later  breathing  became  disturbed  and 
snoring,  and  during  movement  a  loud  nasal  roaring  sound  was  pro- 
duced. 

M.  Audebert,  veterinary  surgeon  at  Vailly  (Cher),  who  diagnosed 
the  existence  of  a  tumour  in  the  left  nasal  cavity,  sent  the  animal  to 
me  on  the  5th  February,  iSgg. 

State  on  Examination. — Animal  moderately  well  nourished.  The 
left  side  of  the  face  showed  a  diffuse,  rather  prominent,  hard  swelling, 
slightly  painful  on  percussion.  From  the  left  nostril  a  greyish,  muco- 
purulent discharge  continually  escaped.  On  examining  the  entrance 
to  the  nostril  nothing  abnormal  could  be  seen,  but  a  short  distance 
within  a  swelling  could  be  felt  which  appeared  formed  by  the  enlarged 
maxillary  turbinated  bone.  The  submaxillary  glands  were  slightly 
swollen.  Breathing  w^as  markedly  embarrassed.  At  a  walk  the  mare 
made  a  loud  roaring  sound. 

Treatment. — Ablation  of  the  tumour.  On  the  gth  Februar}'  the 
patient  was  cast  on  the  right  side.  The  parts  having  been  prepared, 
an  incision  an  inch  and  a  half  in  length  was  made  over  the  left  false 
nostril  in  the  angle  formed  by  the  nasal  and  premaxillary  bones.  A 
portion  of  the  swelling  could  then  be  examined  with  the  finger,  but 
extraction  by  this  orifice  appeared  impossible. 


3l8  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

The  left  nasal  cavity  was  therefore  trephined,  an  incision  about 
three  quarters  of  an  inch  long  being  made  opposite  the  centre  of  the 
nasal  bone ;  at  each  end  two  circular  trephine  openings  were  made, 
and  the  intervening  portion  of  osseous  tissue  removed  with  scissors. 
It  then  became  evident  that  the  anterior  part  of  the  maxillary  tur- 
binated bone  was  markedly  hypertrophied.  On  being  trephined  the 
inferior  maxillary  sinus  was  found  healthy.  The  anterior  part  of  the 
diseased  turbinated  bone  was  first  removed  with  strong  forceps  through 
the  lower  opening,  the  remainder  being  excised  through  the  nasal 
opening.     The  nasal  cavity  and  sinus  were  plugged  with  gauze. 

The  mare  was  returned  to  her  box.  Temperature  38"6°  C.  For 
about  half  an  hour  blood  dripped  from  the  left  nostril. 

All  the  extirpated  portion  of  the  turbinated  bone  was  inflamed, 
thickened,  and  violet  in  colour ;  it  measured  four  inches  in  length  and 
two  to  two  and  a  quarter  inches  in  diameter.  Its  upper  half  was  hard 
and  for  the  most  part  ossified.  Towards  the  centre  it  appeared 
necrotic,  and  contained  a  cavity  filled  with  caseous  pus ;  the  lower 
portion  formed  a  kind  of  ovoid  tumour  measuring  two  inches  in 
length  and  an  inch  and  a  half  in  diameter,  firm  and  homogeneous 
in  consistence,  and  of  a  whitish-red  tint  on  section.  In  the  lower 
portion  of  the  turbinated  bone  the  histological  characters  were  those 
of  inflammatory  hypertrophy,  with  numerous  small  osseous  tracts 
dispersed  through  the  newly-formed  fibrous  tissue. 

On  the  loth  the  tampons  were  removed,  and  the  nasal  cavity 
washed  out  with  warm  boric  solution,  which  brought  away  clots  and 
a  few  fragments  of  necrotic  tissue.  General  condition  and  appetite 
excellent.  Temperature  38*5°  C.  The  nasal  cavity  was  left  open. 
During  the  night  it  was  washed  out  with  boric  solution. 

On  the  nth  the  expired  air  had  the  smell  peculiar  to  caries.  The 
boric  injections  were  alternated  with  creolin  solution.     Temperature 

38-4°  c. 

From  the  12th  to  the  i6th  similar  treatment.  Discharge  remained 
somewhat  free.  The  submaxillary  glands  increased  in  size.  Tem- 
perature normal. 

On  the  17th  the  pus  was  less  abundant  and  less  foetid.  The  warm 
creolin  solution  was  continued. 

On  the  two  following  days  the  patient  showed  symptoms  pointing 
to  mechanical  pneumonia.  The  temperature  was  40*2°  C. ;  the  respi- 
ration 48  per  minute,  whilst  the  pulse  was  only  44. 

On  the  20th  discharge  was  less  abundant,  and  the  general  condition 
had  greatly  improved. 

On  the  2ist  all  unfavourable  symptoms  had  disappeared. 

From  the  22nd  to  the  27th  the  injections  were  continued ;  suppura- 
tion was  trifling.  The  opening  in  the  maxillary  sinus  had  entirely 
closed:  that  in  the  nasal  bone  was  still  open,  but  had  greatly  con- 
tracted.    The  discharge  from  the  nostril  had  considerably  diminished. 

From  the  28th  February  to  the  5th  March  treatment  continued 
the  same.  The  opening  in  the  nasal  bone  had  then  nearly  closed. 
Discharge  was  very  trifling.  Expiration  and  inspiration  were  normal, 
and  scarcely  any  interference  with  inspiration  could  be  detected. 


TUMOURS    IN    THE    NASAL    CAVITIES.  319 

On  the  6th  March  the  mare,  which  was  on  the  way  to  complete 
recovery,  was  returned  home. 

TUMOURS    IN    THE    NASAL    CAVITIES. 

ig.  Five-year- old  terrier  dog.  Left  in  hospital  on  the  14th  March, 
1896. 

About  two  months  before  deformity  of  the  face  had  been  noticed. 
On  the  right  cheek,  almost  midway  between  the  eye  and  point  of  the 
nose,  was  a  circumscribed,  slightly  painful  swelling.  A  muco-purulent 
discharge,  streaked  with  blood,  ran  from  the  right  nostril.  Mastica- 
tion seemed  difficult  ;  the  dog  ate  slowly,  and  frequently  attempted  to 
scratch  the  nose.     The  swelling  gradually  became  more  marked. 

State  on  Entry. — The  right  side  of  the  face  showed  a  swelling  as 
large  as  an  egg,  apparently  developed  in  the  superior  maxillary  bone  ; 
over  its  centre  the  bone  was  destroyed,  and  throughout  the  rest  of  its 
extent  the  external  table  appeared  elevated. 

The  tumour  extended  above  as  high  as  the  eye,  which  however 
appeared  unaffected ;  posteriorly  as  far  as  the  lower  maxilla  ;  it  had 
invaded  the  mouth  and  destroyed  the  right  side  of  the  hard  palate  ; 
several  loose  molars  were  surrounded  by  the  new  growth.  The  buccal 
portion  of  the  tumour  was  in  most  places  fairly  firm,  but  showed  local 
ulcerations. 

Autopsy. — With  the  exception  of  its  ends  the  right  superior  maxilla 
was  almost  destroyed.  The  tumour  extended  about  one  eighth  of  an  inch 
above  the  level  of  the  bone.  After  sawing  through  the  centre  of  the 
head  the  nasal  septum  was  seen  to  be  thrust  towards  the  left  by  the 
growth,  which  had  destroyed  the  mucous  membrane  and  turbinated 
bones,  and  had  completely  filled  the  right  nasal  cavity.  Within  the 
mouth  it  extended  backwards  as  far  as  the  base  of  the  cranium  ;  the 
anterior  portion  of  the  zygomatic  and  palatine  bones  and  the  body  of  the 
superior  maxilla,  together  with  the  right  half  of  the  hard  palate,  were 
destroyed.  Four  molars  (the  crowns  of  which  retained  their  white 
colour)  were  only  held  in  position  by  the  new  growth.  The  anterior 
wall  of  the  orbital  cavity  had  disappeared,  and  the  fibrous  membrane 
lining  it  had  been  thrust  back,  though  it  remained  intact. 

The  buccal  and  maxillary  portions  of  the  tumour  were  somewhat 
firm  ;  the  remainder  was  soft  and  friable.  It  was  of  an  epithelial  nature, 
formed  of  a  connective-tissue  stroma  containing  irregular  cavities 
filled  with  small  polyhedral  cells.  At  certain  points  these  cells 
tended  to  assume  a  cylindrical  form,  and  to  run  at  right  angles  to 
the  stroma.  In  certain  alveoli  the  central  cells  were  large,  contained 
no  nuclei,  and  were  arranged  in  epidermal  nests. 

20.  Four-year-old  sheep-dog.  Brought  for  examination  on  the 
15th  December,  1892. 

Had  been  ill  for  eight  months.  The  first  symptoms  consisted  of 
difficulty  in  breathing,  frequent  sneezing  attacks,  and  discharge  from 
both  nostrils.  The  animal  scratched  the  nose  with  its  paw,  as  if 
attempting  to  remove  some  foreign  body  from  the  nostrils.     Though 


320  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

previously  fond  of  the  water  and  a  very  good  swimmer,  it  now  avoided 
entering  or  soon  returned,  breathing  with  difficulty  and  through  the 
mouth. 

The  face  gradually  became  deformed,  the  anterior  wail  of  the  nasal 
cavities  projected,  especially  on  the  left  side,  the  skin  became  ulce- 
rated over  the  swelling,  and  the  tumour  finally  appeared  externally. 

When  the  dog  was  brought  here  a  blood-stained  discharge  ran  from 
both  nostrils.  The  nasal  cavities  were  obstructed.  Over  the  middle 
of  the  nose  was  a  projecting,  reddish,  bleeding  tumour,  which  had 
perforated  the  bones  and  was  surrounded  by  a  swollen  depilated 
zone. 

Autopsy. — Both  nasal  cavities  were  entirely  filled  by  the  tumour, 
which  was  adherent  over  a  large  surface  to  the  mucous  membrane 
covering  the  floor  of  these  cavities,  whence  it  appeared  to  have 
originated.  It  had  destroyed  the  nasal  septum  and  the  turbinated 
bones.  Below  it  had  advanced  close  to  the  nostrils ;  posteriorly  it 
appeared  bilobed,  the  lower  portion  being  attached  to  the  side  of  the 
palate,  the  upper  portion  extending  towards  the  entrance  to  the 
sinuses,  which  were  filled  with  ill-smelling  pus. 

The  tumour  was  greyish,  and  in  places  somewhat  reddish  in  colour. 


Fig.  28. — Sarcoma  of  the  nose. 

Its  tissue  was  very  soft  and  friable,  and  contained  large  numbers  of 
vessels. 

In  the  posterior  lobe  of  the  left  lung  was  a  tumour  the  size  of  a 
hazel-nut,  projecting  slightly  above  the  surface.  Its  tissue  was  friable 
and  reddish,  resembling  that  of  the  new  growth  in  the  nose. 

On  microscopical  examination  this  tumour  appeared  almost  entirely 
formed  of  round-cells  and  of  vessels  ;  the  cells  were  of  small  size  and 
contained  a  strongly-marked  nucleus,  but  little  protoplasm  ;  in  places 
a  fine  reticulated  stroma  could  be  distinguished.  Most  of  the  sections 
showed  throughout  their  extent  the  histological  characters  of  encepha- 
loid  sarcoma. 


TUMOURS    IN    THE    NASAL    CAVITIES.  321 

21.  Five-year-old  bull-dog.  Brought  for  examination  on  the  7th 
January,  1893. 

Had  been  ill  for  ten  months.  At  first  the  passage  of  air  through 
the  nose  seemed  obstructed  ;  the  animal  sneezed,  showed  discharge, 
and  continually  scratched  the  nose,  the  base  of  which  gradually  be- 
came swollen.  Ulcers  next  formed  at  two  points,  discharged  a 
sticky,  greenish  pus,  and  gradually  increased  in  size,  the  exposed 
tissues  projecting  prominently  and  forming  mushroom-like  growths. 
The  end  of  the  nose  became  twisted  towards  the  left.  A  considerable 
swelling,  more  marked  on  the  right  than  on  the  left,  appeared  between 
the  eyes  over  the  region  of  the  sinuses,  and  on  opening  the  mouth  the 
hard  palate  was  seen  to  be  affected,  the  mucous  membrane  being 
perforated  in  two  places. 

Autopsy. — The  tumour  filled  the  nasal  cavities  and  three  fourths  of 
the  frontal  sinuses.  The  palatine  plate  of  the  superior  maxilla  and  the 
body  of  the  palatine  bone  were  destroyed  for  a  distance  of  one  and  a  half 
inches  in  the  longitudinal  and  three  quarters  of  an  inch  in  the  trans- 
verse direction.  At  the  back,  between  the  sphenoid  and  pter3goid  and 
the  wing  of  the  palatine  bones,  the  tumour  formed  a  thick,  transverse 
prominence  which  projected  into  the  pharynx.  On  either  side  of  the 
median  line  of  the  face,  the  nasal  bone,  the  upper  portion  of  the  maxilla, 
and  the  internal  surface  of  the  frontal  bone  were  destroyed.  At  certain 
points  the  bony  tissue  enclosing  this  area  was  penetrated  by  the  new 
growth.     In  others,  however,  the  two  were  simply  in  juxtaposition. 

The  nasal  septum  was  almost  entirely  destroyed.  In  front  only  a 
fragment  three  quarters  of  an  inch  in  length  and  one  sixteenth  of  an 
inch  in  depth  remained,  fixed  to  the  intermaxillary  bone,  and  behind 
a  sickle-shaped  piece  attached  to  the  vomer  and  ethmoid.  The 
turbinated  bones  were  also  destroyed,  the  only  vestiges  remaining 
being  composed  of  little  parchment-like  lamellae  surrounded  by  the 
tumour.  The  ethmoid  cells  were  only  represented  by  fragments  of 
their  base. 

The  tumour  had  originated  in  the  pituitar}'  membrane  lining  the 
floor  of  the  nasal  cavities.  Thence  it  had  extended  towards  the  base  of 
these  cavities,  next  into  the  sinuses,  whence  it  spread  to  neighbouring 
tissues,  radiating  in  all  directions,  and  perforating  the  bony  partition 
separating  the  nose  from  the  mouth  and  the  mucous  membrane  of  the 
palate. 

The  tissue  of  this  tumour  was  greyish,  very  friable,  and  contained 
numerous  small  vessels.  Histologically  it  showed  the  same  characters 
as  that  of  the  tumour  in  Case  15.  It  was,  in  fact,  a  round-celled 
sarcoma. 

22.  A  five-year-old  spaniel,  which  had  been  ill  for  six  months. 
Brought  for  examination  on  the  13th  February,  1894. 

Difficulty  in  breathing  was  the  first  symptom  noted,  followed  soon 
afterwards  by  double-sided  purulent  discharge,  sometimes  streaked 
with  blood,  and  swelling  of  the  nose,  particularly  towards  the  left  lower 
part.  This  swelling  rapidly  increased.  During  the  early  part  of  Feb- 
ruary the  disease  made  rapid  progress.     The  swelling  extended  to  the 

X 


32  2  CLINICAL   VETERINARY    MEDICINE    AND    SURGERY. 

entire  nasal  region,  towards  the  centre  of  which  a  second  sinus  opened, 
and  suppuration  became  abundant. 

On  examining  the  patient  symptoms  were  seen  analogous  to  those 
noted  in  the  preceding  case,  except  that  deformity  of  the  hard  palate 
and  nasal  lesions  were  more  marked  on  the  left  than  on  the  right  side. 

Autopsy. — The  left  nasal  cavity  was  completely  obstructed  by  the 
tumour,  the  posterior  portion  of  which  extended  as  far  as  the  entrance  to 
the  pharynx  and  into  the  sinuses.  The  nasal  bone,  upper  portion  of  the 
maxilla,  and  internal  table  of  the  frontal  bone  were  at  points  thinned 
and  perforated.  The  nasal  septum  and  ethmoid  cells  were  partially 
destroyed.  In  the  left  cavity  the  tumour  had  not  advanced  so  far 
posteriorly  and  upwardly.  As  in  Case  i6,  the  new  growth  appeared  to 
have  started  in  the  mucous  membrane  of  the  lower  wall  of  the  nasal 
fossa. 

On  section  the  tumour  appeared  whitish-grey  and  fairly  vascular. 
Microscopical  examination  showed  it  to  consist  of  sarcomatous  and 
mucous  tissue  (myxo-sarcoma). 

23.  Three-year-old  setter,  brought  for  examination  on  the  6th 
August,  1894. 

A  year  before  the  animal  had  been  attacked  with  sneezing  fits, 
which  became  more  and  more  frequent.  Greyish  muco-pus,  occasionally 
streaked  with  blood,  ran  from  the  nose.  Some  months  later  the  face 
began  to  swell,  and  gradually  became  more  deformed.  Finally,  the  skin 
ulcerated  over  the  most  prominent  part  of  the  swelling.  For  a  fortnight 
previous  to  entry  blood-stained  pus  escaped  in  considerable  quantities 
by  the  wound  at  this  point. 

When  brought  here  the  animal  was  very  thin  and  appeared  in  severe 
pain.  The  deformity  of  the  face  and  the  existence  in  this  region  of  a 
sinuous  wound  discharging  greyish  pus  clearly  pointed  to  the  nature  of 
the  affection.  On  the  examiner  attempting  to  touch  the  wound  the 
animal  threatened  to  bite.  The  nasal  cavities  were  completely  obstructed, 
and  breathing  was  carried  on  through  the  mouth. 

Post-mortem  Examination. — On  being  opened  along  the  middle  line 
the  nasal  cavities  were  found  entirely  filled  with  the  tumour.  The 
sinuses  were  invaded ;  one  portion  of  the  septum,  together  with  the 
turbinated  bones  and  ethmoid  cells,  had  disappeared.  In  front  the 
tumour  extended  to  the  nostrils,  behind  to  the  pharynx.  The  sinuses 
contained  sticky,  greyish,  offensive  pus. 

This  tumour,  like  the  two  preceding,  appears  to  have  originated 
from  the  pituitary  membrane  lining  the  floor  of  the  nasal  cavities. 
The  macroscopic  and  microscopic  characters  were  similar  to  those  of 
the  new  growth  in  Case  17. 

Remarks. — The  majority  of  tumours  of  the  nasal  cavities  in  the  dog 
are  myxomatous  polypi,  which  tend  to  undergo  conversion  into  sarco- 
mata. When  recent  they  can  be  removed  through  an  incision  in  the 
nasal  bone  and  a  permanent  cure  effected,  but,  as  a  general  rule,  disease 
has  made  such  progress  before  the  patients  are  submitted  to  examina- 
tion that  intervention  is  entirely  useless. 


PURULENT    INFLAMMATION    OF    THE    SINUSES.  323 

PURULENT    INFLAMMATION    OF    THE    SINUSES— 
MENINGO-ENCEPHALITIS. 

24.  Seven-year-old  mare,  affected  with  double-sided  purulent 
inflammation  of  the   sinuses.     Left  in  hospital  on  the  2nd  January, 

The  left  inferior  maxillary  and  frontal  sinuses  had  been  trephined, 
despite  which  the  affection  of  the  sinuses  became  complicated  with 
brain  disease.  The  mare,  was  sent  to  the  School  on  the  evening  of  the 
2nd  January,  and  had  travelled  a  distance  of  five  miles  at  a  walking 
pace. 

State  on  Examination. — The  trephine  openings  in  the  left  frontal  and 
inferior  maxillary  sinuses  were  still  open  ;  their  margins  were  soiled 
with  pus,  and  from  both  nostrils  escaped  a  purulent  ill-smelling  dis- 
charge, more  abundant  on  the  left  than  on  the  right  side.  The  left 
submaxillary  gland  was  swollen,  lobulated,  and  the  size  of  a  small  nut. 
When  placed  in  a  box  the  mare  appeared  exceedingly  depressed.  The 
eyelids  were  swollen  and  half  closed,  and  vision  was  interfered  with, 
principally  on  the  right  side.  During  the  night  the  animal  took  only  a 
little  mash. 

Next  morning  the  condition  was  more  serious.  Prostration  was 
even  more  marked  than  on  the  preceding  evening.  The  mare  moved 
with  great  reluctance ;  the  gait  was  slow  and  uncertain,  movements 
were  irregular,  and  the  limbs  became  flexed  at  every  step.  When 
returned  to  its  box  the  animal  suddenly  showed  alarming  symptoms 
without  any  apparent  cause ;  it  rolled  about,  recovered  itself,  and 
leaned  against  the  wall  with  the  front  limbs  crossed.  In  about  ten 
minutes  it  made  a  few  more  uncertain  steps,  again  dropped  back 
against  the  wall  and  fell  heavily,  stretching  itself  on  the  left  side,  and 
showing  great  excitement,  which  was  succeeded  by  a  period  of  coma. 
At  this  time  the  temperature  was  39'2°  C.  ;  respirations  22  ;  pulse  78 
per  minute. 

For  some  hours  phases  of  excitement  alternated  with  periods  of 
coma.  During  the  former  the  animal  sometimes  lay  on  its  chest,  the 
front  of  the  head  pressed  on  the  ground  ;  sometimes  completely  on  its 
side,  the  head  and  limbs  being  constantly  in  motion. 

Treatment. — Hypodermic  injection  of  morphine  and  chloral  ene- 
mata.  During  the  afternoon  the  coma  was  only  interrupted  bypassing 
fits  of  excitement.  Respiration  and  circulation  became  more  and 
more  rapid,  the  temperature  rose  to  39"8°  C.  The  animal  died  during 
the  night. 

Autopsy. — The  abdominal  viscera  showed  nothing  abnormal.  The 
right  lung,  however,  contained  two  small  centres  resulting  from  chronic 
pneumonia. 

The  head  was  detached  from  the  body  and  sawn  through  longitu- 
dinally near  the  middle  line.  On  examining  the  sinuses  the  mucous 
membrane  was  found  inflamed,  thickened,  and  covered  with  yellowish- 
grey  putrid  pus. 

In  the  antero-inferior  part  of  the  cranium  the  meninges  were 
inflamed,  infiltrated,  thickened,  and  bathed  in  a  sero-purulent  exudate 


324  CLINICAL   VETERINARY    MEDICINE    AND    SURGERY. 

The  corresponding  surface  of  the  brain  was  injected  and  covered  with 
a  similar  fluid,  in  which  streptococci  were  discovered  on  bacteriological 
examination. 

Both  guttural  pouches  were  inflamed,  that  of  the  left  side  being  full 
of  blood-stained  offensive  pus. 


V).— LIPS.— CHEEK.— J  A  WS.— MOUTH.— PHARYNX. 
PSEUDO-CANCROID    OF    THE    LIP. 

25.  Four-year-old  female  cat,  brought  for  examination  on  the 
2ist  April,  1894. 

Had  been  ill  for  a  year.  On  the  centre  of  the  free  border  of  the 
upper  lip  this  cat  had  shown  a  little  flattened,  hard  tumour,  which 
afterwards  became  ulcerated.  The  wound  gradually  extended  on 
either  side  as  far  as  the  labial  commissures,  and  above  to  the  nostrils. 

It  was  of  a  regular,  concave  shape.  The  base  exhibited  a  thin 
indurated  layer.  The  surface  was  reddish  or  greyish  in  colour,  accord- 
ing to  the  point  chosen.  On  examining  it  more  clos-ely  the  red  areas 
were  seen  to  be  regular,  moveable,  and  to  resemble  cicatrices ;  whilst 
the  greyish  points  were  formed  by  little  crusts  covering  shallow  depres- 
sions, apparently  caused  by  extension  of  the  lesion. 

The  ulcer  was  sharply  defined,  and  the  skin  marginating  it  covered 
with  hair.  Where  it  joined  the  mucous  membrane  there  was  neither 
swelling  nor  induration.  The  incisor  and  both  canine  teeth  were 
exposed. 

On  either  side  of  the  upper  part  of  the  neck  were  two  hard  inflamed 
lymphatic  glands  the  size  of  large  peas. 

A  particularly  interesting  feature  was  the  existence  at  the  base  of 
the  dewclaw  of  each  front  foot  of  an  ulcerated  wound  showing  the 
same  appearances  as  that  on  the  upper  lip,  and  only  extending  to  the 
papillary  layer  of  the  skin.  The  greater  portion  of  the  surface  was 
rose-red,  though  greyish  points  could  be  seen  similar  to  those  on  the 
ulcer  of  the  lip.  The  wound  on  the  right  paw  measured  a  little  more 
than  three  quarters  of  an  inch  in  length,  and  about  three  eighths  of  an 
inch  in  width.  It  was  crescent-shaped,  and  surrounded  the  paw.  That 
on  the  left  paw  was  slightly  smaller,  but  situated  at  exactly  the  same 
point. 

These  two  ulcers  occupied  the  part  which  cats  are  in  the  habit  of 
licking  with  the  tongue  when  cleaning  themselves.  They  were  evi- 
dently developed  by  auto-inoculation,  in  consequence  of  repeated  con- 
tact between  the  skin  and  the  labial  ulcer. 

The  patient  was  not  left  in  hospital.  We  prescribed  dressing  the 
ulcers  with  a  20  per  cent,  solution  of  iodine. 

The  animal  was  not  brought  back. 

26.  Six-year-old  male  cat,  left  in  hospital  on  the  20th  May,  1895. 
Two  years  before  had  suffered  from  an  ulcer  of  the  lip.     Recovery 

occurred  spontaneously  after  some  months.     On  the  15th  April,  how- 
ever, a  new  ulcer  was  noted. 


PSEUDO-CANCROID    OF    THE    LIP.  325 

This  growth,  situated  on  the  upper  Hp,  shghtly  to  the  right  of  the 
middle  line,  was  about  a  quarter  of  an  inch  in  length,  and  one  eighth 
inch  in  depth,  its  margin  appearing  as  though  cleanly  punched  out ;  its 
base  was  slightly  hardened,  and  its  surface  covered  with  a  thin,  greyish, 
dry,  adherent  crust.  The  right  submaxillary  gland  was  slightly 
swollen. 

Treatment. — The  parts  were  dressed  daily  with  a  4  per  cent,  solution 
of  chlorate  of  potash,  and  every  third  or  fourth  day  were  swabbed  with 
a  10  per  cent,  solution  of  methylene  blue  (methylene  blue,  ten  parts  : 
alcohol,  fifty  parts;  glycerine,  fifty  parts). 

The  animal  was  very  gentle,  and  made  no  opposition  to  the  dress- 
ing. By  the  beginning  of  June  the  slight  induration  about  the  base  of 
the  ulcer  had  disappeared,  the  extremities  and  the  cutaneous  and 
mucous  margins  were  seen  to  be  healing,  while  the  submaxillary  glands 
were  less  hard. 

Treatment  was  stopped  on  the  15th  June.  Ten  days  later  recovery 
was  complete,  except  for  the  notch  produced  by  ulceration. 

27.  Two-year-old  female  cat,  brought  for  examination  on  the 
igth  April,  i8g6. 

Was  suffering  from  ulcer  of  the  lip.  This  ulcer  had  developed  on 
the  right  side  of  the  upper  lip,  causing  a  crescent-shaped  loss  of  sub- 
stance, about  three  eighths  of  an  inch  in  depth  at  its  centre,  and 
extending  as  far  as  the  right  labial  commissure.  It  was  very  sharply 
defined,  its  base  a  little  indurated,  but  not  painful  on  pressure  ;  the 
surface  was  greyish  in  colour,  and  marginated  by  a  narrow,  pale  red 
line  ;  examined  more  closely  it  appeared  stippled  wath  a  large  number 
of  minute  depressions. 

On  examining  the  jaw  the  right  submaxillary  gland  was  found 
inflamed  and  multilobular. 

Treatment  consisted  in  dressing  the  ulcer  with  methylene  blue. 

This  animal  was  not  brought  back. 

28.  Three-year-old  female  cat,  left  in  hospital  4th  September,  1897. 
Suffering  from  labial  ulcer.     In  October,  i8g6,  it  had  been  brought 

here  on  account  of  a  similar  lesion,  which,  however,  healed  in  a  few 
weeks. 

On  examination  a  large  superficial  ulcer  was  seen  covering  all  the 
left  side  of  the  upper  lip  ;  the  lower  lip  of  the  same  side  close  to  the 
commissure  was  also  invaded  over  a  surface  three  eighths  of  an  inch  in 
length. 

Treatment. — Daily  application  of  methylene  blue  solution. 

Up  to  the  loth  there  was  no  change,  but  during  the  following  days 
fine  granulations  appeared. 

On  the  30th  the  ulcer  had  healed. 

Remarks. — In  the  dog  the  lips,  especially  the  upper,  are  sometimes 
the  seat  of  ulcers  of  an  apparently  cancroid  nature  which,  however,  are 
not  in  reality  due  to  new  growths  but  probably  to  lesions  resembling 
labial  ulcer  in  the  cat. 


326  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 

In  a  four-year-old  watch-dog,  which  showed  an  ulcer  about  one  and 
a  half  inches  in  length  near  the  centre  of  the  upper  lip  with  inflamma- 
tion of  a  lymphatic  gland  in  the  neck,  the  base  and  margins  of  the 
wound  were  hardened,  and  the  microscopical  characters  of  the  lesion 
were  found  to  be  as  follows  : — On  section  of  a  fragment  removed  from 
the  ulcer  and  cut  perpendicularly  to  the  surface  no  epithelial  new 
formation  could  be  detected.  At  a  certain  point  in  these  sections  the 
cells  were  necrotic  and  could  not  be  stained  with  carmine,  though  cells 
in  the  neighbouring  (healthy)  parts  absorbed  it  readily. 

PAPILLARY    SARCOMA    OF    THE    CHEEK. 

29.  Six-year-old  entire  horse,  left  in  hospital  on  the  30th  December, 
1896. 

The  disease  first  appeared  as  a  kind  of  wart  growing  from  behind 
the  left  labial  commissure.  Other  tumours  soon  appeared  and  covered 
a  considerable  surface. 

State  on  Examination. — The  tumour  occupied  the  greater  portion  of 
the  cheek.  It  extended  backwards  from  the  commissure  of  the  lips  to 
within  about  four  inches  of  the  ramus  of  the  lower  jaw,  upwards  as 
high  as  the  forehead,  and  downwards  into  the  intermaxillary  space. 
According  to  the  point  inspected  its  thickness  varied  between  three 
quarters  of  an  inch  and  two  inches.  It  was  sharply  defined  at  its 
periphery,  where  it  met  the  healthy  skin,  and  was  formed  of  two  dis- 
tinct masses  separated  by  a  narrow  depression  running  parallel  to  the 
lower  row  of  teeth,  and  somewhat  obliquely  from  behind  forwards  and 
downwards.  The  shape  of  both  masses  was  irregular ;  their  surface 
rounded  and  bleeding.  The  interspace  was  filled  with  foetid  pus.  The 
submaxillary  gland  was  slightly  swollen,  hard,  insensitive,  and  adherent 
to  the  deeper  structures,  but  not  to  the  skin. 

The  sheath  also  showed  warty  growths,  the  largest  the  size  of  a 
hen's  egg. 

Treatment. — On  the  31st  December  the  horse  was  cast  on  Daviau's 
table,  the  tumour  removed  with  the  knife,  and  the  base  carefully 
curetted.     Haemorrhage  was  checked  by  the  cautery. 

On  section  the  morbid  tissue  was  greyish,  firm,  and  contained  little 
fluid.  Histologically  it  resembled  fasciculated  sarcoma.  It  was  com- 
posed of  large  fusiform  cells  containing  one  or  several  nuclei,  and 
grouped  in  bundles  running  in  various  directions. 

During  the  next  few  days  the  eschar  became  detached.  The  wound 
was  afterwards  touched  with  dilute  tincture  of  iodine  and  covered  with 
tannin.  On  the  12th  January,  when  the  animal  left  hospital,  the  greater 
portion  of  the  wound  was  healed. 

When  seen  again  two  months  later  the  cicatrix  was  flat,  and  there 
had  been  no  return. 

FRACTURE    OF    THE    LOWER    JAW. 

30.  Eight-month-old  poodle,  left  in  hospital  i6th  April,  1892. 
Whilst  playing  in  the  stable  it  was  kicked,  and  on  being  examined 


OSTITIS    OF    THE    INFERIOR    MAXILLA — NECROSIS — (sEQUESTRUM).  327 

the  jaw  was  seen  to  be  pendent  and  blood  to  be  running  from  the  mouth. 
It  was  immediately  brought  to  the  School  for  treatment. 

State  on  Examination. — The  mouth  was  open,  and  discharged  blood- 
stained saliva.  Manipulation  caused  pain,  shown  by  the  animal 
yelping.  Slight  movement  of  the  lower  jaw  produced  crepitation  ;  the 
bone  was  fractured  through  its  neck.  The  left  branch  was  also 
fractured  under  the  masseter  muscle.  The  jaw  was  swollen  and  very 
painful,  and  traumatic  fever  pronounced.  The  pulse  was  120  ;  respira- 
tions 34  ;  and  temperature  39'8°  C. 

Treatment. — A  dressing  formed  of  layers  of  linen  smeared  with 
pitch  was  applied.  This  bandage  covered  the  whole  of  the  lower  jaw, 
and  a  few  turns  were  passed  behind  the  nape  of  the  neck.  The 
fractured  bone  was  also  kept  in  position  by  a  band  of  tarlatan  rolled 
round  the  jaws  and  neck,  several  of  the  turns  crossing  under  the  larynx. 
The  patient  was  spoon-fed  with  liquid  food.  The  mouth  was  washed 
out  with  boric  lotion. 

The  dressing  had  to  be  readjusted  several  times,  and  as  the  animal 
continually  tried  to  remove  it  a  muzzle  was  used. 

On  the  loth  May  the  bandage  was  removed.  The  maxilla  had 
united,  and  the  fragments  were  solidly  fixed  together.  The  dog  was 
fed  with  bread  and  chopped  meat  (without  bone). 

On  the  15th  it  was  able  to  take  its  usual  food.  The  lower  jaw  was 
slightly  deformed  by  the  presence  of  a  callus,  but  showed  no  abnormal 
tenderness. 

OSTITIS    OF    THE    INFERIOR    MAXILLA— NECROSIS— (SEQUESTRUM). 

31.  Six-3^ear-old  gelding,  left  in  hospital  on  the  26th  October,  1897. 

Disease  had  been  caused  by  the  bit.  The  mucous  membrane  of 
the  mouth  had  been  seen  to  be  wounded,  and  the  lower  margin  of  the 
maxilla  swollen.  The  injury  was  first  treated  by  firing,  but  the  swelling 
increased.  An  operation  was  afterwards  performed,  but  gave  unsatis- 
factory results,  a  fistula  remaining.  Six  weeks  later,  as  the  animal  was 
difficult  to  handle,  it  was  sent  here. 

The  outer  margin  of  the  left  branch  of  the  inferior  maxilla,  opposite 
the  bars,  exhibited  a  bony  tumour  the  size  of  a  hen's  egg,  the  centre 
of  which  was  pierced  by  a  fistula  about  two  inches  in  depth.  In  the 
cavity  of  the  mouth  could  be  seen  the  cicatrix  left  by  the  incision  made 
two  months  before  on  first  operating. 

On  the  29th  October  the  horse  was  cast  on  Daviau's  table.  The 
fistula  was  enlarged  with  a  gouge,  revealing  a  sequestrum  as  large  as  a 
hazel-nut  in  the  depth  of  the  bone.  The  inferior  wall  of  the  cavity 
containing  it  being  very  thick  and  hard,  we  decided  to  operate  through 
the  mouth.  The  jaws  were  opened  with  a  gag,  and  the  tush  and 
corner  tooth  of  the  corresponding  side  removed.  Through  the  opening 
thus  made  the  sequestrum  was  easily  removed.  The  margins  of  the 
wound  were  lightly  cauterised,  and  the  wound  itself  plugged  with  gauze 
through  the  cutaneous  orifice.  Each  day  the  dressing  was  renewed  and 
the  wound  washed  out  with  dilute  iodine  solution.  Recovery  occurred 
in  three  weeks. 


328 


CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 


CANCER    OF    THE    INFERIOR    MAXILLA. 

32.  A  ten-year-old  gelding  sent  to  Alfort  on  the  9th  June,  1897,  by 
M.  Candelot,  Veterinary  Surgeon  at  Viarmes  (Seine-et-Oise). 

Five  weeks  before,  during  the  early  part  of  May,  a  sw^elling  as  large 
as  a  hen's  egg  was  seen  to  have  formed  under  the  jaw.  A  veterinary 
surgeon  who  was  consulted  regarded  it  as  a  cold  abscess,  applied  a 
blister,  and  a  few  days  afterwards  fired  it  in  four  places.     A  week  later 


Fig.  29. — Cancer  of  the  inferior  maxilla. 


this  swelling  had  become  five  times  its  original  size,  and  another  had 
developed  on  the  lower  surface  of  the  cheek  which  soon  ulcerated  and 
became  fistulous.  The  disease  grew  rapidly  aggravated,  without,  how- 
ever, producing  general  disturbance.  The  animal  preserved  its  appetite 
and  showed  no  difficulty  in  mastication. 

On  entering  hospital  it  was  still  in  good  condition.     The  lower 


CANCER  OF  THE  INFERIOR  MAXII.LA. 


329 


portion  of  the  right  cheek,  the  jaw,  and  the  intermaxillary  space  were 
occupied  by  a  large  new  growth,  the  outer  part  of  which  was  ulcerated, 
fungous,  and  bleeding.  Owing  to  the  animal  rubbing  the  parts  the 
chest,  shoulders,  and  forearms  were  covered  with  pus  and  blood. 

The  tumour  in  the  intermaxillary  space  was  only  of  metastatic 
origin.  It  covered  8  inches  in  length  and  10  in  width,  and  its  centre 
projected  about  5  inches.  It  was  very  hard,  bosselated,  and  adherent 
to  the  skin,  but  moveable  in  relation  to  the  jaw  and  the  tongue. 

The  tumour  on  the  face  occupied  the  lower  portion  of  the  cheek, 
from  the  middle  third  of  the  masseterto  the  chin.  In  front  it  extended 
beyond  the  zygomatic  ridge ;  behind  it  projected  3  inches  to  3^  inches 
above  the  general  surface,  and  was  in  contact  with  the  tumour  in  the 
intermaxillary  space.  It  was  somewhat  sharply  defined,  showed  a 
peripheral  zone  covered  with  skin,  to  which  it  was  adherent,  and  a 
central  ulcerated,  vegetating,  cauliflower-like  centre  4  inches  across,  in 


Fig.  30. —  Internal  surface  of  the  right  branch  of  the  maxilla. 


the  depths  of  which  probing  revealed  softened,  crepitant  bone.  The 
masseter  was  distinctly  atrophied. 

On  examining  the  buccal  cavity  (which  was  offensive)  the  tumour 
was  found  to  have  perforated  the  inner  table  of  the  maxilla  and  the 
mucous  membrane,  and  filled  up  the  depression  between  the  gums  and 
tongue,  forming  an  elongated  reddish  mass,  which  covered  the  first 
molars. 

The  characters  of  this  new  growth,  but  especially  its  point  of 
origin  in  the  maxilla,  and  its  prompt  extension  to  the  lymphatic  glands 
and  tissues  of  the  cheek  and  mouth,  indicated  its  epithelial  character. 
Histological  examination  of  a  fragment  removed  from  the  margin  of 
the  ulcer  on  the  face  proved  it  to  be  an  epithelioma  of  the  lobulated 
pavement  variety. 

The  animal  was  left  in  hospital  as  a  subject  for  clinical  study.  No 
surgical  treatment  was  possible,  and  none  was  attempted.     The  cancer 


330  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

made  rapid  progress,  as  shown  by  ^vasting,  loss  of  appetite,  and  pale- 
ness of  the  mucovis  membrane.     Death  occurred  on  the  23rd  June. 

Post-mortem  Examination. — General  wasting.  No  growths  in  the 
viscera.  The  head  having  been  sawn  through  along  the  middle  line, 
the  left  branch  of  the  low^er  maxilla  opposite  the  first  molars  appeared 
destroyed  throughout  its  entire  depth.  Around  this  area  of  destruction 
the  branch  of  the  maxilla  was  swollen,  enlarged,  its  two  layers  thrust 
widely  apart,  and  its  tissue  softened.  The  first  and  third  molars  had 
fallen  from  their  alveoli  ;  the  second,  surrounded  by  granulating  tissue, 
was  quite  loose.  The  tumour  in  the  intermaxillary  space  weighed 
4  lbs.  6  oz.  The  buccal  and  facial  portions  of  the  other  new  growth, 
which  occupied  the  entire  depth  of  the  maxilla  and  extended  beyond 
its  margins,  w^eighed  nearly  6  lbs.  6  oz. 

This  case  is  remarkable  for  the  rapidity  with  which  the  cancer 
developed.  In  two  months  it  destroyed  the  central  portion  of  the 
right  branch  of  the  lower  maxilla,  produced  great  disturbance,  and 
caused  troubles  ending  in  general  decline  and  death. 

DENTAL    CARIES. 

2,^.  Five-year-old  mare  affected  with  caries  of  the  second  left 
upper  molar.     Entered  hospital  on  the  loth  November,  1896. 

For  some  time  this  animal  had  been  noticed  to  eat  very  slowly. 
It  masticated  oats  badly,  ate  hay  with  difficulty,  and  seemed  to  prefer 
mashes  and  easily  masticated  food.  It  had  also  been  observed  that 
considerable  quantities  of  fcetid  saliva  mixed  with  food  material  ran 
from  the  mouth,  and  that  the  left  side  of  the  face  exhibited  a  swelling, 
painful  on  pressure. 

Condition  on  Entry. — The  left  side  of  the  face  in  front  of  the  small 
maxillary  sinus  exhibited  a  diffuse,  slightly  painful  sw^elling.  Large 
quantities  of  viscous  stinking  saliva,  mixed  with  food  material,  ran 
from  the  mouth.  A  greenish  muco-purulent  discharge  escaped  from 
both  nostrils,  but  especially  from  the  left.  The  submaxillary  gland 
appeared  as  a  small,  hard,  indolent  swelling,  not  adherent  to  the  base 
of  the  tongue.  The  mouth  was  offensive.  Opposite  the  second  molar 
was  a  depression  in  the  line  of  teeth,  around  which  food  had  accumu- 
lated.    The  gum  and  inner  surface  of  the  cheek  were  inflamed. 

At  exercise  the  animal  produced  a  peculiar  abnormal  sound  during 
respiration,  pointing  to  deformity  of  the  left  nasal  cavity,  a  condition 
verified  by  exploration  with  Gunther's  catheter. 

Diagnosis. — Caries  of  the  second  left  molar,  with  swelling  of  the 
floor  of  the  corresponding  nasal  cavity. 

Treatment. — Removal  of  the  tooth  by  punching.  On  the  nth 
November  the  mare  was  cast  on  the  right  side,  and  the  jaws  having 
been  widely  opened  by  a  gag,  a  V-shaped  incision  was  made  over  the 
root  of  the  tooth,  the  subjacent  tissues  reflected,  and  the  maxilla 
trephined,  giving  exit  to  a  quantity  of  grumous  fcetid  pus  mixed  with 
food. 

After  cleansing  the  cavity  the  punch  was  applied  to  the  root  of  the 
tooth,  which  was  displaced  by  a  few  gentle  blows,  an  assistant  mean- 


DENTAL    FISTULA.  331 

while  controlling  the  progress  of  operation  by  passing  one  hand  into 
the  animal's  mouth. 

The  tooth  having  been  removed  the  opening  was  cleansed  with 
warm  carbolic  solution,  and  plugged  with  gauze.  That  evening  the 
temperature  was  normal. 

Next  day  the  dressing  was  renewed.  The  animal  ate  freely  and 
seemed  to  have  suffered  little  from  the  operation.  Temperature  39'2°  C. 
Discharge  was  less  abundant,  but  breathing  was  still  noisy. 

The  same  treatment  was  continued  on  the  following  days.  The 
wound  showed  no  special  feature. 

On  the  i8th  discharge  had  ceased.  The  external  wound  was 
clean,  and  there  were  no  splinters  or  necrosis. 

Treatment  was  continued  until  the  25th.  Swelling  of  the  face  had 
gradually  diminished,  the  alveolar  cavity  rapidly  filled  up,  and  the 
abnormal  breathing  disappeared. 

DENTAL    FISTULA. 

34.  Eight-year-old  entire  horse  suffering  from  dental  fistula. 
Brought  for  examination  on  the  19th  January,  1899. 

History. — The  disease  had  first  appeared  nearly  two  years  before. 
At  that  time  the  horse  showed  a  slowly  increasing  enlargement  over 
the  anterior  portion  of  the  left  upper  maxilla,  which  was  several  times 
unsuccessfully  blistered  and  once  punctured.  On  the  last  occasion 
pus  escaped,  but  the  enlargement  continued  and  the  wound  became 
fistulous. 

Condition  on  Examination. — Opposite  the  roots  of  the  second  and 
third  molars,  and  at  its  junction  with  the  cheek,  the  left  side  of  the 
face  showed  a  swelling  measuring  three  and  a  quarter  inches  in 
diameter,  the  centre  of  which  was  pierced  by  a  fistula  discharging 
greyish,  putrid  pus.  A  probe  entered  for  a  distance  of  one  and  a  half 
inches,  and  at  that  point  appeared  to  be  checked  by  contact  with  the 
root  of  a  molar  tooth. 

External  manipulation  of  the  parts  produced  little  pain,  but  the 
introduction  of  a  probe  into  the  fistulous  tract  caused  the  animal  to 
struggle  violently. 

The  left  line  of  molars  showed  nothing  abnormal,  no  caries  or 
tumour,  no  fistula  or  gingivitis ;  and  the  buccal  cavity  was  perfectly 
sweet. 

The  long  duration  of  disease,  the  fistula  formation  and  other 
attributes  of  the  swelling,  the  character  of  the  pus,  and  the  absence 
of  lesions  within  the  mouth  pointed  to  the  existence  of  alveolitis 
confined  to  the  space  around  the  root  of  the  tooth,  or  of  caries  of  this 
root. 

Treatment. — On  the  21st  January  the  animal  was  cast  on  the  right 
side  by  means  of  Daviau's  table ;  the  maxilla  trephined  over  the  root 
of  the  second  molar  (which  was  found  to  be  separated  from  its  alveolus 
and  the  point  of  origin  of  the  fistula)  and  the  tooth  punched  out  with 
the  usual  precautions. 

After  operation  the  wound  was  cleansed  and  the  alveolar  cavity 
plugged  with  cotton  wool  surrounded  by  layers  of  gauze. 


332  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

The  root  of  the  tooth  when  examined  was  found  to  be  carious ;  the 
anterior  portion  had  been  destroyed,  and  the  tooth  itself  penetrated  by 
a  deep  narrow  fistula,  into  which  a  wire  penetrated  to  within  about 
three  eighths  of  an  inch  of  the  grinding  surface ;  the  table  itself,  how- 
ever, was  intact. 

No  exact  information  could  be  obtained  as  to  the  cause  of  this 
dental  fistula..  It  was  probably  produced  by  injury  to  the  maxilla 
opposite  the  second  molar,  leading  first  to  ostitis,  then  to  formation 
of  a  necrotic  area,  followed  by  alveolitis  and  caries  of  the  root  of  the 
tooth. 

There  being  no  spare  room  in  hospital  the  horse  was  placed  at 
livery  near  the  College.  During  the  following  few  days  it  was  brought 
to  the  external  clinique.  Every  morning  the  dressing  was  renewed  ; 
the  alveolar  wound  was  exposed,  cleansed,  and  again  plugged.  At  the 
end  of  a  week  a  small  necrotic  area  was  noted  in  the  maxilla  in  front 
of  the  trephine  opening.  It  was  swabbed  with  tincture  of  iodine,  and 
the  little  necrotic  patch  soon  separated. 

From  the  beginning  of  the  second  week  the  dressing  was  only 
renewed  each  second  day.  The  external  wound  and  that  of  the 
alveolus  gradually  closed.  On  the  ist  March  they  had  become 
reduced  to  a  narrow  channel  from  which  only  a  little  pus  escaped ; 
and  in  the  mouth  the  breach  had  almost  entirely  closed. 

At  this  date  the  animal  was  returned  to  work,  recovery  being 
assured. 

35.  A  five-year-old  water-spaniel  left  in  hospital  on  the  17th  August, 
1898. 

For  nearly  a  year  this  animal  had  shown  at  the  base  of  the  lower 
eyelid,  shghtly  in  front  of  and  below  the  eye,  a  fistulous  wound  dis- 
charging foetid,  greyish,  sometimes  blood-stained  pus,  which  had 
irritated  the  skin  of  the  cheek  and  produced  a  bare  patch.  It  had 
been  unsuccessfully  treated  by  antiseptic  injections,  and  by  exposure 
and  cauterisation.  During  the  previous  few  months  the  patient  had 
fallen  away  in  condition. 

On  exploration  the  fistula  was  found  to  terminate  over  the  root  of 
the  last  molar,  around  which  the  gum  was  inflamed  and  retracted. 

Under  proper  control  the  molar  was  extracted  with  dental  forceps. 
It  was  partially  carious.  The  alveolus,  however,  showed  no  necrosis, 
and  was  disinfected  with  iodine  solution,  and  plugged  with  cotton 
wool. 

During  the  four  following  days  the  dressing  was  renewed  daily. 
Afterwards  the  cavity  was  washed  out  night  and  morning  wath  warm 
boric  solution. 

On  the  30th  the  fistula  on  the  face  had  closed,  and  the  alveolar 
opening  to  a  great  extent  filled  up.  Next  day  the  animal  returned 
home. 

36.  A  three-year-old  cat,  with  dental  fistula  opening  on  the  right 
side  of  the  lower  jaw.  Brought  for  examination  on  the  31st  March, 
1896. 


SECTION    OF    THE    TONGUE.  333 

The  fistula  had  been  in  existence  for  about  eight  months.  The 
owner  stated  that  it  had  followed  a  rat  bite.  It  opened  on  the  right 
side  of  the  lower  lip,  and  was  masked  by  the  surrounding  hair ;  the 
track  was  narrow,  its  opening  level  with  the  skin,  and  its  margins  not 
indurated.  A  fine  stilette  introduced  into  the  wound  was  checked  by 
contact  with  a  necrotic  fragment  of  bone. 

The  animal  having  been  fixed  on  the  table,  and  the  jaws  opened 
by  means  of  two  pieces  of  tape,  the  gum  was  seen  to  be  swollen,  red, 
and  retracted  opposite  the  right  canine  tooth,  the  base  of  which 
exhibited  a  thick  deposit  of  tartar.  The  tooth  was  removed,  and  the 
wound  and  fistulous  tract  cleansed  with  a  30  per  cent,  solution  of 
tincture  of  iodine. 

In  ten  days  the  cutaneous  and  buccal  wounds  had  healed. 


SECTION    OF    THE    TONGUE. 

^y.  A  four-year-old  Arab  horse,  brought  from  Marseilles  to  Paris 
in  a  horse-box,  in  which  it  was  fastened  by  means  of  a  rope  passed 
through  the  mouth. 

When  receiving  the  horse  the  owner  noticed  that  the  loop  of  rope 
was  soiled  with  blood.  On  attempting  to  examine  the  mouth  the 
animal  struggled  violently,  but  the  tongue  was  seen  to  exhibit  a  trans- 
verse wound  extending  over  its  entire  width,  slightly  in  front  of  the 
first  molars. 

The  patient  was  brought  to  the  school  three  days  afterwards.  The 
angles  of  the  mouth  were  soiled  with  blood-stained  saliva  ;  the  lower 
lip  and  chin  showed  a  semicircular  superficial  wound,  produced  like 
that  of  the  tongue  by  pressure  of  the  rope.  In  order  to  examine  the 
oral  cavity  a  twitch  had  to  be  applied.  On  opening  the  mouth  a 
foetid  odour  was  observed.  The  left  side  of  the  free  portion  of  the 
tongue  appeared  slightly  swollen  and  red ;  the  right  was  greenish  in 
colour  and  gangrenous.  At  that  time,  however,  the  two  parts  were 
still  in  perfect  continuity  throughout  their  entire  extent,  though  the 
line  of  demarcation  could  be  clearly  seen.  It  extended  exactly  through 
the  centre  of  the  tongue,  except  in  front  where  it  curved  towards  the 
right,  attaining  the  free  margin  about  an  inch  from  the  central  line. 

This  line  of  demarcation,  though  superficial  in  the  left  half  of  the 
tongue,  extended  throughout  the  greater  part  of  the  thickness  of  the 
right  half.  The  inequality  in  depth  explained  the  persistence  of  cir- 
culation in  the  left  half  of  the  organ  and  the  gangrene  of  the  right. 

The  animal  was  fed  on  liquid  food,  like  milk,  gruel,  and  mash,  the 
mouth  being  frequently  washed  out  with  cold  fluids. 

On  the  animal's  return  ten  days  later,  the  gangrenous  portion  of 
the  tongue  was  seen  to  have  become  separated  and  lost.  The  entire 
surface  of  the  wound  was  granulating. 

The  contraction  which  resulted  was  most  marked  in  the  direction 
of  the  thickness  of  the  tongue,  the  free  extremity  of  which  was  only 
drawn  slightly  towards  the  right ;  there  was  no  subsequent  trouble 
either  in  prehension  or  mastication. 


334 


CLINICAL    VETERINARY    INIEDICINE    AND    SURGERY. 


38. 

and,  as 

mouth. 

The 


A  Norman  mare,  brought  from  Caen  to  Paris  in  a  horse-box, 
in  the  preceding  case,  tied  up  with  a  rope  passed  through  the 

tongue  had  been  divided  transversely  throughout  the  greater 
part  of  its  depth,  a  Httle  in  front  of  the  first  molars. 
The  bars,  inner  surface  of  the  lips,  and  labial  com- 
missures were  severely  injured.  The  rope  had  rubbed 
away  the  hair  and  injured  the  skin  about  the  chin,  and 
had  entirely  cut  through  the  lower  lip  of  either  side 
towards  its  free  margin.  The  animal  was  fed  with 
gruel,  and  the  buccal  cavity  frequently  washed  out 
with  cold  water. 

At  the  end  of  forty-eight  hours  the  anterior  portion 
of  the  tongue  had  become  gangrenous.  It  separated 
six  days  later.  The  stump  healed  rapidly,  and  the 
animal  was  returned  to  ordinary  work.  At  first  it  had 
difficulty  in  prehension,  but  soon  became  capable  of 
consuming  its  ordinary  food  consisting  of  oats  and  hay. 

When  seen  two  months  after  the  accident  it  was  in 
good  condition.  The  lingual  cicatrix  was  flexible  and 
fairly  regular,  although  the  tongue  itself  was  drawn 
slightly  to  one  side.  The  stump  extended  about  two 
inches  below  the  first  molars.  Opposite  it  the  de- 
pression normally  existing  between  the  gums  and  lips 
had  disappeared,  the  two  structures  having  become 
adherent. 

Despite  the  mutilation,  there  was  no  difficulty  in 
grasping  or  masticating  food. 


FOREIGN    BODY    IN    THE  MOUTH. 

39.  A  one-year-old  Bordeaux  dog  brought  to  the 
School  on  the  30th  November,  i8g8,  during  the  after- 
noon, by  a  lady  who  was  only  able  to  give  vague  infor- 
mation. She  said  that  the  animal  had  not  eaten  any- 
thing for  several  days,  that  saliva  dribbled  from  the 
mouth,  and  that  a  veterinary  surgeon  who  had  examined 
it  prescribed  treatment  which  proved  unsuccessful. 

This  dog  was  bright  and  did  not  appear  in  pain. 
From  the  corners  of  the  mouth  a  viscous  foetid  saliva 
streaked  with  blood  escaped  in  considerable  quantities. 
The  animal  would  not  take  solid  food,  but  was  able  to 
swallow  warm  milk  given  by  spoonfuls. 

On  examining  it  next  day,  I  suspected  the  presence 
of  a  foreign  body  in  the  mouth  or  pharynx  and  ordered 
these  cavities  to  be  examined. 

The  dog  was  placed  on  the  operating  table  and  the 
mouth  widely  opened  by  means  of  a  speculum.  With  the  exception  of 
abundant  secretions  of  saliva  nothing  abnormal  could  at  first  be  dis- 
covered.    The   odour,    however,    was   excessively   offensive.      Several 


Fig.  31. 


CHRONIC    PHARYNGITIS. 


molars  of  darker  colour  than  the  others  attracted  attention,  but  there 
was  no  caries,  or  inflammation  of  the  gums,  and  some  other  cause  had 
to  be  sought.  On  pressing  down  the  tongue  with  a  spatula  and  moving 
it  from  side  to  side  a  cord  was  noticed  in  the  space  between  the  tongue 
and  gums,  the  centre  portion  surrounding  the  base  of  the  tongue,  and 
the  ends  traversing  the  pharynx  and  entering  the  oesophagus.  It  was 
seized  with  the  fingers  and  removed.  The  appearance  it  presented  is 
shown  by  Fig.  31. 

This  cord  measured  13  inches,  the  loop  alone  being  about  8 
inches  in  length.  Its  free  end  formed  an  irregular  mass  the  size 
of  a  man's  little  finger,  in  which  were  entangled  some  fragments  of 
shavings. 

The  loop  had  slipped  under  the  tongue,  and  been  caught  on  the 
fraenum  linguae,  the  free  portion  passing  backwards  and  entering  the 
pharynx.  It  could  not  be  swallowed,  and  could  only  have  been  expelled 
by  vomiting,  which,  however,  did  not  seem  to  have  occurred. 

Scarcely  had  the  cord  been  removed  than  the  animal  began  to  eat. 
On  returning  to  its  kennel  it  soon  cleared  out  its  feeding  trough. 

In  spite  of  the  stomatitis  which  had  occurred,  recovery  followed 
promptly,  and  the  animal  was  able  to  return  home  on  the  3rd  December. 


CHRONIC    PHARYNGITIS— DOUBLE    HYOVERTEBROTOMY    (OPENING 
OF    THE    GUTTURAL    POUCHES). 

40.  A  fifteen-year-old  gelding.  Entered  hospital  on  the  30th  June, 
1896.  Had  been  left  at  Alfort  to  be  treated  for  pharyngitis  in 
December,  1895,  and  been  removed  before  complete  recovery.  A 
slight  discharge  from  both  nostrils  had  continued,  and  after  some  time 
increased  in  quantity. 

On  returning  to  hospital  this  horse  was  in  rather  thin  condition  ; 
appetite  was  normal,  but  swallowing  difficult.  A  muco-purulent 
discharge  containing  fragments  of  food  ran  from  both  nostrils,  and  part 
of  the  drinking  water,  which  was  at  first  mixed  with  muco-pus,  returned 
by  the  same  channel.  Violent  attacks  of  coughing  occasionally 
occurred.  The  throat  was  neither  painful  nor  swollen.  The  parotid 
region  appeared  normal.  It  was  difficult  to  produce  coughing  by 
pressing  on  the  larynx.  The  submaxillary  glands  contained  two  small 
hard  multilobular  masses.  The  chief  functions  were  regular.  The 
lungs  revealed  nothing  abnormal. 

On  the  4th  July  the  guttural  pouch  of  either  side  was  opened  and  a 
mass  of  gauze  saturated  with  dilute  tincture  of  iodine  was  passed  to  act 
as  a  drain. 

Up  to  the  25th  July  antiseptic  injections  were  made  daily  and  fresh 
strips  of  gauze  saturated  with  iodine  solution  were  passed.  After  that 
time  drainage  was  stopped. 

The  discharge  and  difficulty  in  swallowing  gradually  diminished. 
On  the  28th  the  animal  was  almost  completely  cured,  and  returned 
home.  Trifling  disturbance  remained  for  a  time,  but  finally  dis- 
appeared. 


336  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 


COLD    ABSCESS    IK    THE    RETRO-PHARYNGEAL    GLANDS. 

41.  A  five-year-old  mare,  left  in  hospital  the  nth  June,  1897. 

History. — About  three  months  before  the  stableman  had  noticed  in 
the  submaxillary  and  laryngeal  regions  a  swelling,  which  extended  on 
either  side  over  the  parotid.  Though  at  first  little  marked,  this  swelling 
gradually  increased.  A  little  whitish,  mucous,  inodorous  discharge, 
which  appeared  oftenest  during  work  and  when  the  animal  began  to 
swallow  liquids,  ran  from  the  nostrils.  Deglutition  was  difficult,  and 
the  mare  ate  and  drank  slowly. 

No  useful  information  could  be  obtained  as  to  the  animal's  ante- 
cedents. We  simply  learned  that  it  was  of  American  origin,  and  had 
been  bought  four  months  before. 

State  on  Examination. — In  spite  of  the  difficulty  in  eating,  the  mare 
was  in  good  condition.  The  swelling  of  the  throat  and  parotid  regions 
was  considerable,  was  hard,  resistent,  without  fluctuation,  and  almost 
painless  on  pressure.     The  head  was  held  extended. 

The  submaxillary  gland  was  slightly  swollen,  the  swelling  being  ill- 
defined  and  rather  cedematous  towards  its  periphery.  From  time  to 
time,  and  especially  when  the  animal  drank,  a  whitish,  inodorous  dis- 
charge ran  from  both  nostrils,  though  rather  more  abundantly  from  the 
left,  although  the  swelling  appeared  equal  on  either  side  of  the  throat. 

Treatment. — After  a  week  of  observation  the  upper  part  of  the  right 
guttural  pouch  was  opened  and  a  counter  opening  made  in  the  usual 
way.  No  pus  escaped,  but  a  drainage-tube  was  nevertheless  intro- 
duced. A  similar  operation  was  performed  on  the  other  side  with  like 
result. 

The  animal  was  left  at  liberty  in  a  box.  During  the  afternoon  it 
appeared  dull  and  hardly  touched  food.  The  guttural  pouches  were 
washed  out  with  a  warm  solution  of  iodine  and  iodide  of  potassium. 

On  the  following  days  the  parotid  regions  increased  in  size  and 
became  very  tender.  Mastication  and  deglutition  appeared  painful, 
and  there  was  difficulty  in  flexing  the  neck.  The  temperature  only  rose 
a  few  tenths  of  a  degree.  Each  morning  the  drainage-tubes  were 
replaced.     The  patient  was  fed  on  gruel  and  milk. 

On  the  22nd  creamy  pus  escaped  by  the  drainage-tubes ;  the 
swelling  decreased,  especially  on  the  left  side ;  difficulty  in  swallowing 
was  less  marked  ;  discharge  ceased  ;  and  the  extension  of  the  head  and 
stiffness  about  the  neck  diminished. 

During  the  following  week  the  swelling  due  to  operation  lessened  in 
the  upper  half  of  the  parotid  region,  but  persisted  in  the  lower.  Imnie- 
diately  above  the  origin  of  the  trachea  a  sweUing  formed,  and  steadily 
became  more  clearly  circumscribed,  giving  the  impression  of  a  deep- 
seated  cold  abscess  or  of  a  tumour.  During  the  first  week  of  July 
these  local  symptoms  remained  unchanged.  Further  operation  was 
decided  on. 

On  the  gth  the  mare  was  cast  on  Daviau's  table.  The  head  was 
firmly  fixed  in  a  position  of  extension,  and  the  skin  covering  Viborg's 
triangle  washed,  shaved,  and  disinfected.  A  cutaneous  incision  about 
6  inches  in  length  was  then  made  immediately  above  and  parallel  to 


COIJ)    AHSCKSS    IN    THK    kETRO-PHARVNGEAL    GLANDS.  337 

the  external  maxillary  vein.  B}'  careful  dissection  the  skin,  subcu- 
taneous fascia,  parotid  gland,  and  subjacent  aponeurosis  were  retiected. 
On  passing  the  finger  behind  the  left  guttural  pouch  a  large,  rounded, 
uniform,  resistent  swelling,  without  the  least  fluctuation,  was  detected. 
For  the  moment  it  was  doubtful  whether  this  represented  a  new  growth 
or  a  cold  abscess  in  the  retro-pharyngeal  glands.  The  end  of  a  grooved 
director  was  introduced,  guided  by  the  left  index  finger,  and  was  pushed 
in  the  direction  of  the  centre  of  the  swelling.  It  appeared  to  enter, 
and  some  whitish  laudable  pus  escaped.  The  tract  was  enlarged,  and 
about  a  pint  of  similar  pus  evacuated.  The  abscess  cavity  was  washed 
out,  a  rubber  drainage-tube  inserted  and  fixed  to  the  skin,  and  the 
animal  allowed  to  rise.  On  entering  the  stable  it  at  once  began  to  eat 
some  oats,  which  it  swallowed  without  difficulty.  The  swelling  about 
the  throat  had  almost  entirely  disappeared,  and  the  head  and  neck 
were  moved  freel}-.  During  the  evening  and  following  da3S  the  abscess 
cavity  was  washed  out  with  antiseptic  solutions.  Suppuration  was 
trifling. 

On  the  14th  the  drainage-tube  was  removed.  On  the  20th  the 
guttural  region  had  resumed  its  ordinary  appearance,  except  for  the 
cicatrix  of  the  operation  wound.  Respiration  was  unaffected,  and 
appeared  normal  at  all  paces. 


II.— NECK. 


WOUND    OF    THE    NECK. 


42.  A  nine-year-old  gelding  suffering  from  a  wound  in  the  region 
of  the  neck,  left  in  hospital  the  i8th  November,  1898. 

On  the  i6th  November  when  out  for  exercise  this  horse  had  reared 
up  when  passing  close  to  a  man  carrying  a  scythe,  and  the  cutting 
edge  of  the  implement  had  entered  the  neck,  producing  a  large  wound 
(Fig.  32). 

State  oil  entering  Hospital. — The   patient  was  brought  to  hospital 


Fig.  32. 

two  days  after  the  accident.  On  the  left  side  of  the  neck  was  a  wound 
about  tw-elve  inches  in  length,  running  obliquely  forwards  and  down- 
w^ards,  extending  from  the  upper  border  of  the  neck  to  within  an  inch 
and  a  half  of  the  jugular  furrow.  Its  anterior  extremity  was  almost  in 
contact  with  the  lower  jaw.  Above,  it  passed  across  the  upper  margin 
of  the  neck,  and  for  a  further  distance  of  three  inches  over  the  right 


POLL-EVIL.  339 

side.  The  tissues  covering  the  upper  part  of  the  neck  were  completely, 
and  the  ligamentum  nuchas  partially  divided,  especially  on  the  left 
side. 

Towards  its  centre  the  wound  was  six  inches  broad  and  three  to 
three  and  a  half  inches  deep.  Opposite  the  line  of  the  vertebras  it  was 
two  and  a  half  inches  in  depth,  and  extended  through  the  muscular  tis- 
sues. The  upper  part  was  somewhat  shallower.  The  greater  portion 
of  both  surfaces  of  the  wound  was  covered  with  dried  exudate,  and  the 
deeper  portions  contained  masses  of  blood-clot.  The  animal  was 
depressed  and  feverish  ;  it  only  ate  a  portion  of  its  food  ;  the  tempera- 
ture was  39*5°  C. 

Treatment. — Thorough  disinfection  of  the  wound  with  a  warm  one 
per  thousand  solution  of  sublimate,  insertion  of  deep-seated  sutures,  and 
application  of  moist  antiseptic  compresses. 

November  20th. — The  wound  had  become  clean.  Some  fragments 
of  dead  tissue  had  been  shed.  Suppuration  was  trifling.  Temperature 
39-2°  C. 

During  the  following  days  the  wound  granulated  over  its  entire 
surface.  The  muscular  layers  became  united.  The  depressions  filled 
up  and  suppuration  remained  slight.  In  spite  of  the  extent  and  depth 
of  the  wound  the  neck  was  easily  moved  in  all  directions.  The  appetite 
was  good,  and  the  temperature  normal. 

On  the  5th  December  the  use  of  moist  compresses  was  discontinued, 
the  wound  being  simply  washed  out  night  and  morning  with  an  anti- 
septic solution.  On  the  20th  it  had  almost  filled  up ;  the  margins  were 
nearly  in  contact,  and  at  the  widest  part  were  only  separated  by  a 
distance  of  an  inch  and  a  quarter. 

POLL-EVIL. 

43.  Fifteen-year-old  gelding,  sent  to  the  School  from  the  Pasteur 
Institute  on  the  27th  February,  i8g8. 

It  had  first  been  treated  at  the  infirmary  of  the  Institute  for  an  open 
sinus  on  the  left  side  of  the  head.  Carbolic  and  sublimate  injections 
had  proved  unsuccessful. 

On  the  28th  the  horse  was  cast  on  the  right  side.  The  sinus,  which 
opened  almost  on  the  median  line,  extended  obliquely  downwards  and 
backwards  parallel  to  the  ligamentum  nuchas,  and  was  about  six  inches 
in  depth. 

Treatment. — The  sinus  was  exposed  and  a  counter-opening  formed. 
A  gauze  drain  was  inserted,  and  the  parts  washed  out  night  and  morn- 
ing with  30  per  cent,  tincture  of  iodine,  and  with  Villate's  solution.  A 
prophylactic  injection  of  antitetanic  serum  was  given. 

Though  continued  until  the  15th  March  this  treatment  by  drainage 
and  injections  produced  no  improvement.  Operation  for  poll-e\'il  was 
then  decided  on. 

The  animal  was  cast  on  the  table,  and  the  cordiform  portion  of  the 
ligamentum  nuchas  removed  up  to  the  point  where  it  becomes  inserted 
into  the  occipital  bone,  the  latter  being  scraped.  The  wound  was 
cleansed  with  warm  sublimate  solution,  powdered  with  iodoform,  and 


340  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

covered  with  compresses  of  iodoform  gauze,  over  which  was  appHed  a 
compress  dressing  of  cotton  wool  kept  in  position  by  three  bandages. 

On  the  second  day  after  operation  the  dressing  was  removed  and 
the  wound  washed  out  with  warm  subhmate  solution.  A  fresh  gauze 
and  cotton-wool  dressing  was  applied.  The  dressings  were  changed 
every  second  day  until  the  3rd  Ma}-,  when  the  wound  was  granulating 
throughout. 

SINUS    OF    THE    NECK. 

44.  Eight-year-old  gelding,  left  in  hospital  the  27th  August,  i8g8. 
For  the  previous  three  weeks  this  horse  had  shown  a  diffuse,  very 

tender  swelling  in  the  upper  part  of  the  neck,  the  centre  of  the  swelling 
being  occupied  by  a  large  partially  detached  slough,  which  appeared  to 
extend  deeply  towards  the  ligamentum  nuchae. 

Treatment. — The  greater  part  of  the  dead  tissue  was  excised.  Two 
incisions  in  the  shape  of  a  cross  were  made,  one  in  the  axis  of  the  neck, 
the  other  transverse  to  it ;  and  in  addition  a  counter-opening  was 
made  on  the  right  side,  in  which  a  strip  of  gauze  was  placed  to  act  as 
a  drainage-tube.  Night  and  morning  the  wound  was  disinfected,  the 
margins  powdered  with  bicarbonate  of  soda,  and  the  parts  covered  with 
compresses  saturated  with  warm  5  per  cent,  bicarbonate  of  soda  solu- 
tion. This  treatment  was  continued  for  a  week.  Suppuration  remained 
abundant,  and  the  swelling  large  and  painful. 

From  the  5th  September  the  parts  were  dressed  with  a  weak 
solution  of  formalin  and  a  mixture  of  calomel  and  iodoform.  This 
treatment  proved  very  successful.  The  wound  soon  assumed  a  better 
appearance.  The  pus  became  thicker  and  less  abundant,  while  the 
parts  lost  their  extreme  sensibility. 

On  the  30th  September  the  necrotic  portions  of  the  ligament  had 
separated,  and  the  entire  surface  of  the  wound  was  actively  granulating. 
The  neighbourhood  of  the  wound  still  remained  very  sensiti\'e  in  conse- 
quence of  irritation  of  the  skin. 

MOIST    GANGRENE    IN    THE    NECK    REGION. 

45.  A  thirteen-year-old  entire  horse,    left  in   hospital   28th  April, 

^893-   .         . 

This  animal  had  been  injured  a  little  in  front  of  the  withers  by  the 
collar.  The  neighbourhood  of  the  wound  and  the  upper  margin  and 
sides  of  the  neck  became  much  swollen.  A  veterinary  surgeon 
punctured  the  swelling  on  both  sides  with  a  pointed  firing-iron,  but 
tumefaction  increased  during  the  following  days. 

State  on  Examination. — Depression ;  loss  of  appetite  ;  anxious 
appearance  of  the  face  ;  mucous  membranes  cyanotic  ;  respiration  and 
circulation  rapid  ;  temperature  39*6°  C.  The  whole  of  the  neck  was 
enormously  swollen  ;  sloughing  had  occurred  in  the  upper  half,  and  the 
lower  was  cedematous.  At  the  centre  of  the  upper  margin  was  a  sinus 
into  which  almost  half  a  litre  of  liquid  could  be  injected.  On  the  right 
side  the  necrotic  parts  were  beginning  to  separate. 


PHLKBITIS    OF    THE    JUGULAR    VEIN.  34I 

Treatment. — Attempts  were  made  to  check  the  extension  of  gangrene 
on  the  left  side  of  the  neck  by  applying  about  thirty  deep  punctures  with 
the  firing  iron,  into  which  was  injected  30  per  cent,  tincture  of  iodine 
containing  iodide  of  potassium.  The  parts  were  sprayed  with  carbolic 
solution.  Alcohol,  carbolic  acid,  and  bicarbonate  of  soda  were  given 
internally.     The  evening  temperature  was  40*2^  C. 

April  30th. — The  general  condition  had  improved.  The  mucous 
membranes  were  less  injected  ;  the  pulse  and  respiration  less  frequent. 
The  animal  took  a  part  of  its  food.  The  general  symptoms  were  no 
longer  alarming.  Separation  of  the  dead  parts  had  begun  on  the  left 
side.  The  eschar  measured  fourteen  inches  in  length  and  varied 
between  four  and  seven  inches  in  breadth.  The  parts  were  sprayed 
with  carbolic  solution  three  times  daily  and  covered  with  a  thick  com- 
press saturated  in  one  per  thousand  solution  of  sublimate. 

May  3rd. — Improvement  was  progressive.  Appetite  had  returned, 
and  each  day  delimitation  was  more  marked. 

May  6th. — The  eschar  not  yet  being  completely  delimited,  the 
grer.ter  portion  was  excised.  A  mass  weighing  nearl\-  six  pounds  was 
removed.  In  front  a  gangrenous  patch  about  four  inches  in  length 
remained.  To  prevent  necrosis  extending  in  the  funicular  portion  of 
the  ligament  cervical  desmotomy  (division  of  the  cordiform  portion  of 
the  ligamentum  nuchte)  was  performed.  Antiseptic  treatment  was 
continued. 

May  gth. — The  remaining  necrotic  patch  was  excised.  It  weighed 
a  little  more  than  two  pounds. 

May  loth  to  27th. — The  wound  became  clean,  and  granulated 
actively.  The  loss  of  tissue  was  gradually  replaced.  Up  to  the  loth 
June  a  sinuous  tract  remained,  originating  from  a  necrotic  fragment  of 
the  ligamentum  nuchas. 

The  animal  left  hospital  on  the  15th  June.  The  wound  was  granu- 
lating throughout,  and  recovery  was  certain. 

PHLEBITIS    OF    THE    JUGULAR    VEIN. 

46.  Five-year-old  entire  horse,  left  in  hospital  on  the  30th  De- 
cember, i8g6. 

The  animal  had  been  bled,  and  in  consequence  a  large  thrombus 
had  formed. 

From  the  site  of  the  operation  wound  up  to  the  parotid  the  jugular 
furrow  was  sw^ollen,  hot,  oedematous,  and  painful.  The  wound  was 
sinuous,  and  a  director  could  be  passed  into  the  vein. 

The  sinus  was  laid  open  for  a  long  distance  in  the  axis  of  the 
vessel ;  its  walls  were  curetted,  disinfected  with  strong  carbolic  solu- 
tion and  tincture  of  iodine,  and  plugged  with  iodoform  gauze. 

During  the  succeeding  days  the  dressing  was  renewed  daily,  the 
wound  cleansed  by  spraying  with  carbolic  solution,  and  dusted  with 
calomel.     Suppuration  was  trifling,  and  healing  regular. 

On  the  8th  January  a  little  perivenous  abscess,  which  had  de- 
veloped about  an  inch  above  the  wound,  was  punctured.  The  cavity 
was  cleansed  and  treated  with  antiseptic  injections. 

Cure  was  complete  in  a  fortnight. 


342  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

47.  A  seven-year-old  in-foal  mare,  left  in  hospital  r8th  February, 
1897. 

About  six  weeks  before  the  animal  had  been  bled  from  the  left 
jugular.  Phlebitis  resulted,  and  was  treated  by  laying  open  the  parts 
and  cleansing  with  disinfectant  lotions.  Recovery  appeared  to  be 
taking  place  when  the  parotid  region  became  inflamed. 

On  examining  the  animal  on  the  nth  February  we  discovered  a 
subparotid  abscess  developed  between  the  middle  and  upper  thirds  of 
the  gland.  It  was  punctured  and  washed  out  with  30  per  cent,  iodine 
solution.  The  condition  becoming  aggravated,  the  animal  was  left  in 
hospital  on  the  i8th  February. 

State  on  Entry. — The  entire  left  parotid  region  was  greatly  swollen 
and  very  painful.  The  swelling  extended  from  the  wound  in  the  vein 
to  the  temporo-maxillary  region  and  back  of  the  neck,  passing  round 
the  base  of  the  ear.  The  subparotid  abscess  communicated  with  the 
wound  in  the  vein.  The  animal  discharged  from  the  left  nostril.  It 
.refused  part  of  its  food. 

Treatment. — Drainage  of  the  vein  and  injection  of  the  sinus  with 
30  per  cent,  solution  of  iodine  and  iodide  of  potassium. 

On  the  igth  February  two  small  abscesses  had  developed  above 
the  first,  and  were  opened.     They  contained  little  pus. 

On  the  22nd  two  more  abscesses  were  opened  ;  one,  of  considerable 
size,  had  developed  behind  the  parotid,  the  other  near  the  base  of  the 
ear.  The  cavities  were  cleansed,  and  the  sinus  irrigated  with  iodine 
solution.  A  fragment  of  the  gland  tissue  was  removed.  When  feeding 
saliva  escaped  by  the  parotid  wounds. 

On  the  25th  a  deep-seated  abscess  opened  in  the  pharynx,  and  pus 
escaped  by  the  nostrils. 

On  the  28th  another  parotid  abscess  was  opened,  and  a  counter- 
opening  made  in  Mborg's  triangle. 

From  this  time  onwards  improvement  was  steady. 

On  the  17th  March  drainage  of  the  vein  was  stopped. 

A  week  later  the  wounds  had  healed.  The  parotid  region  and 
upper  part  of  the  jugular  furrow  remained  slightly  swollen,  but  the 
swelling  soon  afterwards  disappeared. 

48.  Six-year-old  mare,  left  in  hospital  on  the  nth  January,  1897. 
A  month  before  the  animal  had  suffered  from   strangles,  and  had 

been  bled  from  the  left  jugular. 

The  patient  was  brought  in  an  ambulance,  and  was  so  thin  and 
feeble  as  to  require  support  when  walking.  Scarcely  any  weight  was 
borne  on  the  near  hind  limb.  On  being  placed  in  a  box  it  soon  fell 
into  a  comatose  state,  remaining  quite  still,  the  eyes  half  closed,  the 
head  depressed,  the  limbs  brought  together  under  the  body  ;  from  time 
to  time  the  animal  was  obliged  to  lean  for  support  against  the  wall. 

The  mouth  was  hot  and  dr}- ;  the  conjunctiva  yellowish  in  colour  ; 
the  pulse  80,  small  and  thready  ;  respirations  22  ;  temperature  39"5°  C. 

The  hair  had  been  removed  from  the  left  parotid  region  b}'  the 
action  of  vesicants.  In  the  upper  part  of  the  jugular  furrow  was  a 
warm,  slightly  painful  swelling,  extending  over  the  parotid,  and  show- 


PHLEBITIS    OF    THE    JUGULAR    VEIN.  343 

ing  a  sinuous  wound  which  discharged  blood-streaked  pus.     Another 
wound  existed  about  the  centre  of  the  parotid  region. 

In  the  oedematous  tissue  filHng  the  left  side  of  the  submaxillary 
space,  a  large,  irregular,  slightly  sensitive  swelling  formed  by  the 
submaxillar}'  gland  could  be  felt. 

A  large  swelling  covered  the  region  of  the  sternum  and  extended 
beyond  the  ensiform  cartilage. 

The  left  haunch  was  atrophied  ;  the  right  showed  a  cool,  slightly 
painful  swelling,  specially  marked  over  the  region  of  the  coxo-femoral 
joint.  The  left  hock  was  swollen,  denuded  of  hair  by  blistering  ;  and 
exhibited  on  the  lower  and  inner  surface  a  small  wound  discharging 
whitish  pus. 

Nothing  abnormal  could  be  detected  on  percussing  and  auscultating 
the  chest.  Rectal  exploration  failed  to  discover  signs  of  intra-pelvic 
abscess. 

Treatment. — The  wounds  were  washed  wdth  antiseptics,  creolin 
being  used  in  the  fistulous  portion  of  the  jugular ;  and  warm  creolin 
enemata  were  administered  during  the  evening.  Milk,  hay  tea, 
brandy,  and  bicarbonate  of  soda  were  gi\en  internally.  The  patient 
readily  took  gruel. 

Next  day  the  animal  seemed  less  depressed.  The  local  symptoms 
remained  unchanged.  Discharge  of  pus  was  facilitated  by  inserting 
drainage-tubes  in  the  fistulous  portion  of  the  vein.  The  swelling  under 
the  chest  showed  iiuctuation,  and  on  being  opened  discharged  a  pint  of 
pus ;  it  was  washed  out  and  disinfected  several  times  during  the  da}'. 
The  swelling  in  the  coxo-femoral  region  was  stationar}-.  In  order  to 
prepare  for  operation  the  hair  was  shaved  and  the  skin  disinfected  over 
an  area  the  size  of  a  man's  hand,  but  exploratory  puncture  was  deferred, 
as  the  position  of  the  abscess  was  uncertain.  The  internal  treatment 
was  continued.     The  evening  temperature  was  40*5^  C. 

On  the  13th  there  was  little  improvement  though  the  \ein  sup- 
purated less  than  on  the  previous  day.  In  order  to  check  extension 
towards  the  base  of  the  jugular  a  few  deep  punctures  were  made  with 
the  firing-iron  in  the  upper  part  of  the  parotid  region.  Antiseptic 
injections  into  the  fistulous  vein  and  into  the  purulent  cavity  beneath 
the  sternum  were  continued.  Temperature  40  C.  Internal  treatment 
continued.      Evening  teinperature  40*3°  C.      Respirations  20. 

On  the  14th  January  temperature  40*6°  C  ;  respirations  26.  No 
striking  change  except  a  diminution  in  size  of  the  swelling  in  the  coxo- 
femoral  region.  During  the  evening  the  mare  lay  down  and  groaned  a 
good  deal.  She  received  an  enema  containing  chloral.  Temperature 
40*5°  C.     Died  during  the  night. 

Autopsy. — -The  peritoneum,  ecchymosed  in  places,  contained  a  little 
yellowish  serous  fluid.  The  liver,  spleen,  and  kidne}'S  were  congested. 
In  the  depths  of  the  right  haunch  was  a  collection  of  pus  surrounding 
the  hip-joint. 

The  left  pulmonary  lobe  contained  about  fifteen  little  purulent 
centres;  the  pericardium  about  one  pint  of  yellowish  serous  fluid. 
The  myocardium  showed  no  lesions,  though  the  endocardium  exhibited 
a  few  ecch}-moses. 


344 


CLINICAL    VETERINARY    MEDICINE    ANIJ    SURGERY. 


On  dissecting  the  parotid  region  phlebitis  ^vas  seen  to  have  extended 
a  considerable  distance  beyond  the  parotid  fistula.  The  subzygomatic 
and  internal  maxillary  veins  had  become  affected. 

On  dividing  the  head  along  the  middle  line  the  meninges  appeared 
inflamed,  thickened,  and  bathed  in  a  purulent  exudate,  in  which 
bacteriological  examination  revealed  the  presence  of  strepto-  and 
staphylococci. 

EXTENSIVE    LACERATED  WOUND    IN    NECK    OF    HORSE;     RUPTURE 
OF    THE    TRACHEA;     RECOVERY. 

49-   Light  van  horse,  seen  23rd  July,  1896. 

History. — Had  been  struck  about  the  middle  of  the  neck  by  the 
pole  of  a  two-horse  van  (see  Fig.  ^^). 

State  on  Examination. — The  animal  showed  two  wounds  in  the  neck 
and  one  in  the  pectoral  region.     The  largest  was  on  the  off  side  of  the 


Fig.  33. — The  larger  wound  is  shown  white;  the  position  of  the  smaller  is  indicated 
by  the  arrow;  the  pole  head  is  shown  within  lines. 


neck,  about  midway  between  the  angle  of  the  jaw  and  pomt  of  the 
shoulder.  A  large  irregular  fragment  of  skin  about  three  and  a  half 
inches  in  either  direction  had  been  entirely  torn  away,  and  on  insert- 
ing the  finger  into  the  wound  two  channels  could  be  detected,  one 


forki(;n  body  in  the  a<:soPHAGUS.  345 

about  three  and  a  half  inches  in  length  passing  downwards  and  back- 
wards, following  the  direction  of  the  levator  humeri  muscle ;  the 
other  upwards  and  forwards,  and  towards  the  opposite  (nearj  side  of 
the  neck.  As  the  finger  penetrated  more  deeply  the  rough  broken 
edges  of  a  tracheal  ring  could  be  felt,  and  during  inspiration  and  ex- 
piration air  rushed  in  or  was  forced  out,  producing  a  loud  bubbling 
sound.  The  tissues  were  extensively  bruised,  and  the  skin  torn  away 
from  subjacent  structures  for  a  considerable  distance.  The  wound  on 
the  near  side  of  the  neck  was  three  to  four  inches  below  the  angle  of  the 
jaw,  and  measured  two  and  a  half  inches  by  half  an  inch.  It  communi- 
cated with  that  of  the  opposite  side  by  a  channel  running  downwards 
and  backwards,  so  that  by  standing  in  front  of  the  animal  and  gently 
passing  the  forefingers  in  from  either  side  they  could  be  caused  to 
meet  just  in  front  of  the  trachea. 

Treatment. — The  wounds  were  thoroughly  explored  and  cleansed, 
care  being  taken  to  avoid  the  use  of  much  fiuid  which  might  have 
passed  into  the  trachea.  To  facilitate  the  freest  possible  drainage  no 
stitches  were  inserted.  The  parts  were  cautiously  injected  three  times 
daily  with  5  per  cent.  "  Sanitas  "  solution,  care  being  taken  to  reach 
the  bottom,  and  the  neighbourhood  of  the  wounds  was  carefully 
cleansed.      Low  diet. 

On  the  24th  July  the  wounds  and  surrounding  parts  were  greatly 
swollen,  but  discharge  was  not  offensive.  Until  the  2gth  the  wounds 
and  neighbouring  parts  were  much  swollen,  but  on  that  date  swelling 
began  to  subside.  There  was  slight  fever  and  rather  high  pulse  rate 
for  the  first  few  days,  but  this  soon  subsided.  Appetite  was  preserved 
throughout. 

On  the  8th  August  both  wounds  had  closed  and  were  granulating 
freely.  A  week  later  the  horse  returned  to  work.  A  year  afterwards 
the  horse  showed  very  slight  traces  of  the  accident,  and  breathing 
was  normal. 

Mr.  Jno.  A.  W.  Dollar's  case,  Veterinarian,  1896,  p.  672. 

FOREIGN    BODY    IN    THE    (ESOPHAGUS. 

50.  A  seven-year-old  entire  horse,  left  in  hospital  on  the  i8th 
February,  1897. 

When  being  taken  out  of  harness  this  horse  passed  near  a  heap  of 
sliced  carrots,  and  picking  up  a  few  pieces  hastily  swallowed  them. 
Almost  immediately  it  showed  grave  disturbance,  violent  excitement, 
efforts  to  swallow,  and  abundant  salivation.  It  was  brought  to  hospital 
during  the  evening. 

The  animal  made  continued  attempts  to  swallow.  A  little  saliva 
ran  from  the  mouth  ;  the  head  was  slightly  extended  on  the  neck ; 
respiration  was  increased,  and  cough  frequent.  In  the  jugular  furrow 
a  little  below  the  larynx  was  a  well-defined  swelling.  Palpation  left 
no  doubt  as  to  the  nature  of  the  condition,  viz.  obstruction  of  the 
oesophagus. 

The  animal  was  cast  on  the  table  and  chloroform  administered. 
The  jaws  were  opened  with  a  gag,  and  the  first  portion  of  the  oesophagus 
examined.     No  foreign  body  could  be  detected.      Taxis  was  employed, 


346  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

and  the  probang  passed  without  success.  As  the  obstruction  might 
probably  become  softened  in  a  short  time  further  surgical  intervention 
was  deferred. 

The  animal  was  allowed  to  rise,  and  placed  in  a  box  from  which  the 
litter  had  been  removed,  in  order  to  prevent  it  attempting  to  eat, 
thus  introducing  material  into  the  trachea.  A  hypodermic  injection  of 
pilocarpine  and  eserine  was  given. 

For  half  to  three  quarters  of  an  hour  salivation  was  ver}-  abundant, 
and  swallowing  efforts  very  frequent ;  then  the  symptoms  suddenly  dis- 
appeared ;  the  foreign  body  had  passed  onwards  into  the  stomach. 
The  point  at  which  it  had  been  arrested  remained  sensitive  for  some 
days,  but  there  was  no  subsequent  difficulty  in  swallowing. 

51.  Two-year-old  sheep-dog,  left  in  hospital  on  the  2nd  January, 

This  animal  was  in  the  habit  of  fetching  and  carrying,  and  was  fond 
of  playing  with  objects  given  it  for  this  purpose.  During  the  last  few 
days  of  December  it  had  appeared  ver}-  dull,  had  refused  to  eat,  and 
shown  swelling  of  the  throat. 

Condition  on  Entry. — The  dog  was  dull,  held  the  head  depressed, 
and  refused  food.  The  guttural  region  showed  a  hard,  cool,  insensitive 
swelling,  the  size  of  a  small  egg,  without  local  fluctuation.  This  was 
first  regarded  as  a  cold  abscess  in  course  of  formation. 

On  the  two  following  days  there  was  no  local  change.  The  animal 
refused  all  food,  and  had  to  be  spoon-fed  with  milk. 

On  the  5th  January  the  hair  covering  the  centre  of  the  swelling  was 
glued  together  by  pus,  and  the  skin  seen  to  he  penetrated  by  a  small 
opening.  To  evacuate  the  contents  of  the  abscess  slight  pressure  was 
exercised  over  the  swelling  on  either  side  of  the  wound,  when  the  end 
of  a  fragment  of  knitting-needle,  two  and  a  half  inches  in  length  and 
covered  with  sanguinolent  pus,  was  seen  to  be  projecting. 

The  fistula  having  been  laid  open  a  director  was  passed  nearly  two 
inches  in  a  direction  almost  perpendicular  to  the  surface  of  the  region. 
The  wound  in  the  oesophagus  healed.  When  the  animal  drank,  no 
liquid  escaped  by  the  fistula. 

As  often  happens  when  sharp  objects  are  swallowed  by  dogs,  this 
needle  had  become  implanted  in  the  walls  of  the  pharynx  or  com- 
mencement of  the  oesophagus,  had  passed  through  them  under  the 
influence  of  the  swallowing  movements  to  which  it  gave  rise,  and 
become  implanted  in  the  tissues  of  the  neck,  where  it  had  produced  the 
above-mentioned  swelling  ;  and  had  finally  attained  the  skin,  causing 
ulceration. 

The  next  day,  in  spite  of  the  needle  having  been  removed,  the 
animal  appeared  dull,  moved  slowly,  and  refused  food.  Milk  diet  was 
therefore  continued. 

On  the  7th  the  condition  was  the  same,  and  the  bowels  were  con- 
stipated. No  faeces  were  passed.  An  ounce  of  castor  oil  was  given, 
and  warm  water  enemas  administered.  During  the  day  some  dry, 
earth)-  faeces,  streaked  with  blood,  were  voided. 

On  the  8th  the  warm  water  enemas  were  continued.     Suddenly  the 


SURGICAL    TREATMENT    OP'    CHROMC    ROARING — HEMIPLEGIA    LARVNGIS.    347 

animal  made  violent  expulsive  efforts,  and  passed  by  the  anus  a  ball  of 
worsted.  By  the  evening  it  was  bright,  and  ate  some  of  its  ordinar}' 
food. 

During  the  following  days  improvement  increased,  the  animal 
became  brighter,  and  appetite  returned. 

On  the  loth  the  swelling  about  the  neck  had  disappeared,  and  only 
a  narrow  fistula  remained,  discharging  a  trifling  amount  of  serous  pus. 

The  wound  had  closed  on  the  15th,  when  the  animal  left  hospital. 

FCETID    PURULENT    ABSCESS    IX    THE    NECK    OF    A    CAT    CAUSED 

BY    A    NEEDLE. 

52.  Subject. — A  five-year-old  male  tabby  cat. 

History. — Had  suffered  from  catarrhal  fever  in  April,  1892.  For  a 
fortnight  before  examination  had  appeared  restless  and  in  pain, 
appetite  was  capricious,  and  at  times  there  was  slight  vomiting  ; 
the  right  side  of  the  neck  from  the  jaw  to  the  shoulder  became 
swollen. 

State  on  Examination  (on  September  3rd,  1892). — The  swelling  in 
neck  was  painful  and  fluctuating,  and  had  commenced  to  point. 

Treatment. — The  abscess  was  opened  an  inch  below  seat  of  pointing 
to  afford  freer  drainage  ;  about  six  ounces  of  foetid  pus  escaped.  The 
cavity  was  irrigated  with  weak  creolin  solution,  and  the  parts  covered 
with  a  sublimate  cotton-wool  dressing. 

Until  September  6th  appetite  and  general  condition  impro\ed,  the 
abscess  cavity  diminished,  and  health}-  granulations  formed. 

On  September  7th  the  animal  appeared  worse,  and  on  the  8th  was 
again  brought  for  inspection.  A  piece  of  grey  worsted  three  inches  in 
length  was  removed  from  the  cavity,  and  on  search  a  needle  was  dis- 
covered to  the  right  of  the  splenius  muscle  ;  its  e3^e  was  uppermost, 
level  with  the  superior  border  of  the  muscle,  and  about  two  inches 
distant  from  the  head  :  the  needle  was  inclined  obliquel}-  from  above 
downwards  and  forwards  towards  the  pharynx  ;  it  was  two  inches  in 
length,  and  black  in  colour.  Evidently  it  had  penetrated  from  the 
mouth. 

The  patient  died  on  the  loth  September. 

Autopsy. — The  pleural  cavities  contained  eight  ounces  of  oftensi\'e 
hsemorrhagic  purulent  exudate,  in  which  floated  a  few  flakes  of 
lymph  ;  this  exudate  formed  a  jelly  after  a  few  minutes.  The  pleura 
pulmonalis  showed  a  few  flakes  of  slightly  adherent  lymph  ;  the 
mediastinal  pleura  was  inflamed,  thickened,  and  friable.  The  centre  of 
the  right  lung  was  consolidated.  Petechia;  were  visible  on  the  epi- 
cardium.  With  the  exception  of  a  cheesy  gland  near  the  inferior 
ligament  of  the  liver  the  abdominal  viscera  were  healthy.  No  tubercle 
bacilli  were  found  on  microscopical  examination. 

Mr.  H.  Gra_v's  case,  Joiirn.  Coiiip.  Path,  and  Therap.,  1S92,  p.  381. 

SURGICAL    TREATMENT    OF    CHRONIC    ROARING-- 
HEMIPLEGIA    LARYNGIS. 

53.  A  seven-3ear-old  Norman  mare  belonging  to  M.  M — ,  232, 
Faubourg   St.    Honore.    Paris,   affected    with  intense  chronic  roaring. 


34^  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

This  animal  came  to  a  standstill  after  trotting  lOO  yards.  Left  in 
hospital  the  i6th  September,  1895. 

Exercised  in  the  riding  school  on  the  morning  after  arrival  it  almost 
immediately  began  to  roar  loudly.  Respiration  soon  became  painful, 
and  dyspnoea  so  marked  as  to  prevent  it  continuing. 

Operation  was  performed  on  the  i8th.  The  animal  was  placed  on 
its  back,  the  head  firmly  fixed  in  a  position  of  extension.  The  region 
of  the  larynx  having  been  prepared  by  clipping  away  the  hair,  and 
shaving  and  disinfecting  the  skin,  the  skin  and  subcutaneous  muscular 
layers  were  incised  from  opposite  the  body  of  the  thyroid  as  far  as  the 
second  tracheal  ring.  After  checking  haemorrhage  I  opened  the  larynx 
in  the  median  line,  dividing  the  crico-thyroid  ligament,  cricoid  cartilage, 
crico-tracheal  ligament,  and  first  ring  of  the  trachea.  The  larynx  was 
then  widely  opened,  and  the  left  arytaenoid  seen  to  be  completely 
paralysed.  It  remained  motionless  during  both  periods  of  respiration, 
whilst  the  right  moved  to  the  normal  extent.  Having  introduced  into 
the  trachea  a  cannula  padded  with  gauze  I  excised  the  left  arytaenoid  by 
the  method  described  in  the  preceding  portion  of  the  present  work 
(p.  31).  With  cutting  forceps  I  also  removed  the  greater  portion  of 
the  fragment  of  cartilage  left  by  the  bistoury  opposite  the  crico- 
arytaenoid  articulation.  Two  rectangular  tampons  of  gauze  were 
arranged  side  by  side  in  the  larynx,  and  three  interrupted  silk  sutures 
inserted  to  bring  together  the  muscular  layers  and  to  fix  the  tampons. 
The  skin  was  also  sutured  and  covered  with  a  layer  of  collodion.  On 
rising  the  mare  was  placed  in  a  box  without  litter.  No  food  was  given. 
The  evening  temperature  was  38*8°  C. 

Next  morning  two  of  the  sutures  were  cut  and  removed.  The 
dressing  and  the  cannula  were  changed.  After  cleansing  the  wound 
with  tampons  of  wadding  held  in  forceps  the  skin  and  muscular  layers 
of  each  lip  were  sutured  together.  The  patient  received  and  ate  its 
ordinary  allowance  of  food.  Swallowing  was  somewhat  difficult, 
especially  in  the  case  of  fibrous  food.  Portions  of  the  latter  and  of  the 
drinking-water  escaped  from  the  laryngeal  wound.  Temperature, 
morning,  38*6°  C. ;  evening,  38-9°  C. 

During  the  next  three  days  difficulty  in  swallowing  persisted  ;  a 
little  of  the  drinking-water  escaped  by  the  wound.  Temperature, 
morning,  38'5°  C.  ;  evening,  39*3°  C  Particular  care  was  taken  in 
cleansing  the  external  wound. 

After  the  23rd  the  difficulty  in  swallowing  diminished.  The  wound 
granulated  over  the  entire  surface. 

From  the  24th  to  the  30th  nothing  particular  occurred.  The 
wound  suppurated  slightly,  and  gradually  contracted.  Neither  food 
nor  liquid  passed  through  it.  Temperature,  morning,  37*9°  C  ;  even- 
ing, 38*3°  C.  From  the  28th  2  to  zh  drachms  of  iodide  of  potassium 
were  given  daily  in  the  drinking-water. 

During  the  first  week  of  October  the  animal  showed  signs  of  sore 
throat,  including  discharge  from  both  nostrils  and  cough.  This,  how- 
ever, diminished,  and  during  the  following  week  disappeared.  On  the 
i6th  October  the  external  wound  had  closed. 

On  the  20th  and  22nd  the  mare  was  exercised  at  a  trot  in  the  riding 


SURGICAL    TREATMENT    OF    CHRONIC    ROARING — HEMIPLEGIA    LARVXGIS.    349 

school.  There  was  still  a  slight  abnormal  sound  during  inspiration, 
but  the  dyspnoea  and  difficult}'  in  breathing,  which  had  been  so  marked 
before  operation,  had  disappeared. 

The  animal  was  returned  to  M.  M —  on  the  28th  October,  and  went 
to  work  during  the  early  part  of  November.  It  worked  in  a  brougham 
without  interruption  and  without  showing  any  difficult)'  with  breathing. 
Eighteen  months  later  the  owner  made  the  following  statement  : 

"  Since  leaving  the  school  the  mare  has  worked  every  day.  For 
the  first  three  weeks  breathing  was  still  a  little  noisy,  but  during  the 
course  of  December  this  trouble  disappeared,  and  since  then  I  have 
never  heard  any  roaring,  even  in  heavy  work." 

54.  An  eight-year-old  Anglo-Norman  horse  belonging  to  M.  M — , 
232,  Faubourg  St.  Honore,  Paris,  left  in  hospital  13th  June,  1896. 

Had  commenced  to  roar  about  a  year  before.  The  difficult}'  in 
breathing  gradually  increased.  At  the  time  of  entry  the  horse  was 
incapable  of  trotting  work. 

Tested  in  the  riding  school  it  roared  very  loudly  in  a  few  minutes. 

On  the  15th  June  it  was  operated  on  under  chloroform,  and  the  left 
arytsenoid  cartilage  removed.  A  small  fragment  of  the  articular  angle 
was  left.  Dressing  was  carried  out  as  in  the  first  subject.  Two  hours 
after  operation  the  temperature  was  3g'3*^  C,  and  in  the  evening 
39'6°  C.     No  food  was  given  for  the  first  twenty-four  hours. 

Next  morning  the  dressing  and  cannula  were  removed.  The  skin 
and  muscular  tissues  of  each  lip  were  sutured  together.  On  returning 
to  its  box  the  horse  drank  a  bucket  of  water  placed  on  the  ground  and 
began  to  eat.  It  consumed  all  its  food,  though  swallowing  was  a  little 
painful ;  the  meal  was  interrupted  by  attacks  of  coughing,  and  water, 
oats,  and  fragments  of  hay  were  discharged  through  the  wound.  In 
the  intervals  the  horse  appeared  a  little  dull  and  depressed.  Tempera- 
ture, morning  39*1°  C,  evening  39*4°  C.  After-treatment  simply 
consisted  in  cleansing  the  external  wound  night  and  morning. 

On  the  17th  the  depression  seen  on  the  previous  evening  had  dis- 
appeared. Temperature  38*4°  C.  Inspiration  was  difficult  and  noisy. 
The  margins  of  the  wound  were  drawn  apart.  When  eating  a  little 
water  and  food  escaped  from  the  orifice.  During  the  following  da}'s 
the  difficulty  in  swallowing  diminished,  respiration  became  quiet,  and 
the  temperature  fell  to  normal. 

On  the  22nd  the  muscular  sutures  were  removed.  Neither  food 
nor  drinking-water  passed  by  the  wound.  The  lips  were  granulating 
over  their  entire  surface.  Iodide  of  potassium  was  then  commenced. 
The  wound  gradually  contracted. 

By  the  nth  July  the  larynx  had  closed.  On  the  17th  the  wound 
was  entirely  healed. 

On  the  i8th  and  19th  the  horse  was  trotted  in  the  riding  school. 
At  the  end  of  five  or  six  minutes  the  inspiratory  sound  became  marked, 
but  was  very  different  both  in  character  and  intensity  from  that  noted 
before  operation.  During  the  first  week  of  August  the  animal  returned 
to  work  in  a  brougham,  work  for  which  its  roaring  had  previously 
unfitted  it. 


350  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

In  September,  1897,  M.  M —  sent  me  the  following  report : 
"  Since    operation    the    horse    has    worked    very    well.       In    warm 
weather  the  roaring  sound  still  occurs,  but  to  a  very  trifling  extent,  and 
does  not  prevent  the  horse  being  perfectly  '  workable.' " 

55.  A  ten-year-old  Dutch  mare,  belonging  to  M.  S — ,  6,  Rue  Dieu, 
Paris,  affected  with  chronic  roaring,  which  appeared  to  have  developed 
after  bronchitis.     Left  in  hospital  20th  October,  1895. 

The  roaring  was  noticed  when  the  animal  first  returned  to  work 
after  illness,  and  gradually  became  more  marked  despite  internal  treat- 
ment. The  animal  could  still  be  worked,  but  respiration  was  difficult, 
and  dyspnoea  continually  appeared  imminent. 

Trotted  in  the  riding  school  the  mare  roared  loudly.  By  con- 
tinuing for  a  few  minutes  longer  dyspnoea  was  produced  ;  the  flank 
movements  were  very  rapid,  the  nostrils  widely  dilated;  inspiration 
was  painful,  and  the  appearance  of  the  face  anxious.  Nothing 
abnormal  was  found  on  examining  the  nasal  cavities,  larynx,  and 
trachea. 

Operation  on  the  22nd  October.  The  parts  having  been  prepared 
the  lower  surface  of  the  larynx  and  the  first  tracheal  ring  were  incised. 
On  dilating  the  wound  paralysis  of  the  left  arytenoid  was  detected. 
The  cartilage  was  removed,  the  parts  dressed  with  gauze,  double 
muscular  and  cutaneous  sutures  inserted,  and  the  animal  was  placed  in 
a  box  without  litter.     The  evening  temperature  was  38*7°  C. 

Next  day  the  dressing  and  cannula  were  removed  ;  the  muscular 
layers  were  united  to  the  skin  on  each  side  by  three  interrupted 
sutures.  Litter  was  again  provided.  Food  and  drink  were  given  as 
usual    after    operation.       Temperature,    morning    38*3°   C,     evening 

38-5°  C.  .  .     . 

During  the  following  days  a  portion  of  the  drinking-water  and 
fragments  of  food  mixed  with  saliva  returned  through  the  nostrils  and 
operation  wound.  Feeding  was  interrupted  by  attacks  of  coughing. 
Temperature,  morning  38'2°  C,  evening  38-9°  C. 

On  the  ist  November  the  difficulty  in  swallowing  had  disappeared. 
The  laryngeal  wound  was  covered  with  granulations  and  reduced  in 
length  to  one  half.  Neither  food  nor  liquid  escaped  by  it.  Adminis- 
tration of  iodide  of  potassium  was  commenced.  On  the  15th  the 
wound  had  closed.     The  animal  left  hospital  on  the  24th  November. 

Result. — At  the  commencement  of  December  the  mare  returned  to 
work.  A  little  whistling  was  then  noticed  at  a  trot.  By  June,  1896, 
this  had  disappeared  even  at  the  fastest  paces.  Nothing  more  than 
rather  loud  respiration  could  be  detected.  There  was  no  roaring 
sound,  nor  was  the  respiration  in  any  wise  impeded. 

56.  A  nine-year-old  Hungarian  horse,  belonging  to  M.  S — ,  6,  Rue 
Dieu,  Paris,  suffering  from  chronic  roaring.  Left  in  hospital  24th 
September,  1896. 

Had  been  in  M.  S — 's  possession  for  five  months.  The  roaring 
varied  in  intensity  from  time  to  time.  Occasionally  there  was  cough- 
ing and  slight  whitish,  frothy  discharge  from  both  nostrils.     M.   S — 


SURGICAL    TREATMENT    OF    CHRONIC    ROARING HEMIPLEGIA    LARYNGIS.    35 1 

declared  that  the  animal  could  not  work  at  a  trot,  and  on  leaving  it 
with  us  insisted  on  my  at  once  performing  the  same  operation  on  it  as 
was  practised  on  his  other  horse. 

External  examination  of  the  larynx  and  trachea  revealed  nothing 
abnormal.  After  a  few  minutes'  trotting  the  horse  produced  a  roaring 
sound,  which  rapidly  became  aggravated.  This  test  was  repeated  each 
morning  for  the  following  three  days.  On  each  occasion  whistling 
occurred  after  a  couple  of  minutes,  and  soon  became  very  loud,  while 
dyspnoea  threatened. 

Operation  on  the  28th  under  chloroform  anaesthesia.  The  larynx 
was  opened  and  paralysis  of  the  left  arytsenoid  detected.  I  removed 
the  cartilage,  leaving  a  small  fragment  of  the  articular  angle  in  the 
depths.  The  intra-laryngeal  wound  was  not  sutured.  A  gauze  dress- 
ing was  inserted  and  fixed  in  position  by  two  sutures  passed  through 
the  skin  and  muscle.     The  sutures  also  served  to  steady  the  cannula. 

The  animal  did  not  rise  until  ten  minutes  after  the  hobbles  had 
been  removed.  It  was  then  returned  to  its  box  and  kept  without  food 
for  twenty-four  hours.  Morning  temperature  38°  C. ;  evening  tempera- 
ture 38-4°  C. 

Next  day  the  sutures  were  cut,  the  dressing  and  cannula  removed, 
and  the  superficial  wound  cleansed.  The  skin  and  muscular  layers  of 
each  lip  were  united  by  three  interrupted  sutures.  To  facilitate  breath- 
ing the  lips  of  the  wound  were  kept  widely  open  for  some  days.  The 
patient  was  placed  on  ordinary  diet,  which  it  ate  with  good  appetite. 
A  little  saliva,  water,  and  food  escaped  by  the  wound..  Temperature, 
morning  38*8°  C,  evening  39'5°  C 

During  the  following  days  treatment  was  confined  to  cleansing  the 
external  wound  night  and  morning  with  fragments  of  wadding  held  in 
dressing  forceps. 

From  the  7th  October  food  and  liquid  ceased  to  escape  by  the 
larynx.  From  the  loth  to  the  30th  2  to  2^  drachms  of  iodide  of 
potassium  were  given  daily  in  the  drinking-water.  On  the  23rd  the 
superficial  wound  had  completely  healed. 

On  the  28th  the  horse  was  trotted  and  galloped  in  the  riding  school. 
At  the  end  of  ten  minutes  at  a  trot,  and  of  five  minutes  at  a  gallop, 
slight  abnormal  breathing  sounds  were  still  audible. 

M.  S —  kept  this  horse  for  work.  He  reported  on  the  21st  January, 
1899: 

"  During  the  months  following  its  return  to  work  the  horse  was 
able  to  make  long  and  rapid  journeys  without  showing  more  than 
slightly  noisy  breathing.  On  starting  out  it  coughed  and  discharged 
a  little  whitish  mucus  from  the  nose  for  the  first  mile.  Even  at  the 
present  time  there  is  a  slight  discharge  on  commencing  work,  but  once 
the  animal  warms  to  its  work  respiration  becomes  normal,  even  at  a 
rapid  trot.  In  harness  this  horse  has  made  continuous  journeys  of 
fifteen  miles  without  being  distressed,  and  has  often  made  the  double 
journey,  amounting  in  all  to  thirty  miles,  with  a  rest  of  one  hour  half- 
way. In  the  saddle  it  roars  a  little  at  rapid  paces,  but  the  sound 
ceases  when  the  horse  has  galloped  rapidly  for  some  distance  or  after 
it  has  jumped.     It  is  perfectly  useful  for  all  kinds  of  work." 


352  CLINICAl,    VETKKINARV    AIKDICINK    AND    SURdEKV. 

57.  A  six-year-old  Anglo-Norman  horse,  left  in  hospital  24th 
January,  1895. 

In  March,  1894,  this  horse  had  suffered  from  pneumonia.  On  return- 
ing to  work  towards  the  end  of  the  following  month  it  had  shown 
difficulty  in  breathing,  which  was  noisy.  During  the  hot  weather  the 
roaring  increased  and  the  animal  underwent  various  treatment,  but 
without  improvement.     It  was  finally  sent  to  Alfort  to  be  operated  on. 

Nothing  abnormal  was  detected  on  exploring  the  nostrils  and  nasal 
cavities,  or  on  externally  examining  the  larynx  and  trachea.  At  a  slow 
trot  the  horse  roared  after  five  minutes.  When  pushed  it  almost 
immediately  began  to  whistle  loudl}-,  producing  a  noise  audible  from  a 
considerable  distance  ;  respiration  became  painful,  the  nostrils  dilated, 
and  the  animal,  though  in  very  good  condition,  was  obliged  to  slacken 
its  pace. 

Having  been  prepared  for  several  days  and  submitted  to  two  further 
tests,  which  gave  results  similar  to  the  first,  the  horse  was  subjected  to 
operation  on  the  28th  January  under  chloroform. 

The  larynx  having  been  opened,  the  left  arytaenoid  was  seen  to  be 
paralysed.  The  cartilage  was  removed,  only  a  very  small  fragment  of 
the  articular  angle  being  left,  and  at  the  same  time  the  vocal  cord  was 
excised.  The  mucous  membrane  was  not  sutured.  The  parts  were 
dressed  with  gauze,  and  sutures  passed  through  the  muscles  fixing  the 
gauze  and  cannula  in  position.     The  skin  was  separately  sutured. 

The  animal  was  kept  without  food  throughout  the  day.  After-treat- 
ment was  similar  to  that  in  the  preceding  case.  From  the  second  to 
the  fifth  day  the  temperature  oscillated  between  39°  C.  and  39'7°  C. 
Up  to  the  loth  February  saliva,  drinking-water,  and  fragments  of  food 
passed  into  the  larynx.  After  the  latter  date  the  external  wound  healed 
rapidly.  On  the  8th  administration  of  iodide  of  potassium  had  been 
commenced.     On  the  17th  February  the  wound  was  closed. 

When  exercised  in  the  riding  school  on  the  ist,  3rd,  and  5th  of 
March,  the  horse  roared  much  more  loudly  than  before  operation. 

It  left  hospital  on  the  7th  March.  Some  days  afterwards  tracheo- 
tomy became  necessar}-. 

58.  Four-year-old  Norman  horse  suffering  from  severe  roaring, 
which  prevented  its  being  used.  Left  in  hospital  on  the  31st  August, 
1898. 

When  ridden  in  the  riding  school  a  roaring  sound  was  produced  in 
a  few  minutes,  and  rapidly  grew  more  marked. 

On  the  5th  September  operation  was  performed  ;  the  left  arytjenoid 
cartilage  and  internal  wall  of  the  corresponding  ventricle  of  the  larynx 
were  removed.  Dressing  and  after-treatment  were  similar  to  those  in 
the  preceding  cases. 

Next  day  the  morning  temperature  was  39"i°  C.  ;  evening  tempera- 
ture 5g'8°  C.     On  the  7th  the  temperature  again  became  normal. 

Until  the  nth  a  little  liquid  and  fragments  of  food  passed  through 
the  laryngeal  wound.  After  the  12th,  li  to  3  drachms  of  potassium 
iodide  were  given  daily  in  the  water.  Trifling  discharge  occurred  from 
both  nostrils. 


SURGICAL    TREATMENT    OF    CHRONIC    ROARING —HEMIPLEGIA    LARVNGIS.    353 

On  the  22nd  the  external  wound  had  closed.  Discharge  stil] 
continued,  but  gradually  diminished  during  the  succeeding  few  days, 
and  disappeared  a  week  later. 

On  the  5th  October  exercise  was  commenced,  a  quarter  of  an 
hour's  walk  being  given  every  morning.  During  the  first  few  days  the 
horse  was  seized  with  violent  fits  of  coughing  on  leaving  the  stable. 

On  the  7th  it  was  exercised  in  the  riding  school.  Roaring  occurred 
after  a  few  minutes'  exercise.  Two  days  later  it  was  again  tried  at  a 
trot ;  in  three  minutes  the  test  had  to  be  given  up,  so  severe  was  the 
roaring. 

During  the  night  of  the  3rd  November  the  respiration  suddenly 
became  extremely  difficult  and  asphyxia  threatened.  Tracheotomy 
was  therefore  performed. 

Some  days  later  the  larynx  was  reopened.  The  seat  of  operation 
was  occupied  by  a  contracting  cicatrix,  extending  the  entire  depth  of 
the  larynx. 

Remark. — I  could  relate  a  number  of  cases  showing  the  value  of 
arytsenoidectomy,  and  the  failure  of  other  methods  of  operation.  I 
have  chosen  the  most  characteristic.  Two  horses  belonging  to  one 
owner,  M.  M — ,  treated  by  ablation  of  the  arytaenoid,  were  both  cured. 
Two  horses  also  belonging  to  one  owner,  M.  S — ,  and  treated  in  the 
same  way,  were  also  quite  cured. 

The  true  value  of  those  other  operations  which  have  been  so  greatly 
vaunted  is  shown  by  the  results  of  Cases  50  and  51.  With  them  one 
may  rely  on  ensuring  the  greatest  possible  chance  of  failure. 


III.— THORAX. 


FISTULOUS     WITHERS. 


59.  A  ten-year-old  Irish  mare,  sent  for  examination  on  the  30th 
January,  i8gg. 

For  several  years  this  mare  had  been  exclusively  used  for  saddle 
work.  Towards  the  end  of  December,  1898,  a  hsematoma  developed 
on  the  withers,  was  punctured  on  either  side  at  its  lowest  point,  the 
cavity  injected  with  antiseptic  liquids,  and  the  surface  repeatedly 
blistered. 

The  wound  on  the  right  side  closed  in  three  weeks,  but  that  on  the 
left  suppurated  and  became  sinuous.  The  pus,  which  had  difficulty 
in  escaping,  macerated  the  supra-spinous  ligament,  which  became 
necrotic. 

State  on  Examination.  The  right  side  of  the  withers  was  marked  by 
a  cicatrix  ;  the  left,  especially  towards  its  posterior  part,  exhibited  a 
diffuse,  very  tender  swelling,  pierced  about  an  inch  from  the  highest 
point  of  the  dorsal  spinous  processes  by  a  sinuous  wound  into  which  a 
probe  penetrated  for  a  distance  of  nearly  four  inches.  Blood-stained 
pus  ran  from  the  opening. 

The  sinuous  tract  ran  obliquely  forwards  and  slightly  upwards, 
appearing  to  end  over  the  portion  of  the  supra-spinous  ligament 
covering  the  fifth  dorsal  vertebra. 

Treatment. — On  the  30th  January  the  sinus  was  laid  open  parallel 
to  the  line  of  the  superior  spinous  process  for  a  distance  of  four  inches, 
exposing  the  necrotic  portion  of  the  ligament,  which  was  excised  with 
the  bistoury  and  curette.  The  wound  was  cleansed,  the  margins  were 
touched  with  tincture  of  iodine,  the  parts  powdered  with  iodoform,  the 
edges  brought  together  by  three  sutures,  and  covered  with  layers  of 
iodoform  gauze  fixed  in  position  with  collodion. 

The  dressing  was  renewed  every  second  day  until  the  loth  February', 
at  which  time  the  back  portion  of  the  wound  was  granulating,  though 
a  fresh  necrotic  point  had  developed  in  front. 

On  the  nth  February  the  animal  was  cast  and  the  anterior  angle 
of  the  wound  laid  open,  when  the  cartilaginous  disc  covering  the 
superior  spinous  process  and  a  part  of  the  supra-spinous  ligament  were 
seen  to  be  necrotic.  With  the  help  of  the  bistoury  and  curette  the 
dead  structures  were  removed.  The  wound  was  washed  with  one  per 
thousand  sublimate  solution  and  dressed  with  tannoform. 

During  the  following  days  suppuration  was  trifling,  and  hopes  of 
cure  were  entertained.  After  a  period  of  real  improvement  a  fresh 
complication    occurred :    at  the   commencement   of  March    the   liga- 


FISTULOUS    WITHERS. 


355 


mentous  tissue  covering  the  sides  of  the  superior  spinous  process  of 
the  third  dorsal  vertebra  became  necrotic. 

The  mare  was  left  in  hospital  on  the  5th  March.  At  that  date  the 
dead  tissue  was  removed.  The  dressings  used  were  3  per  cent,  creolin, 
tincture  of  iodine,  iodoform,  and  iodoform  gauze. 

On  the  i2th  March  the  skin  was  seen  to  have  become  separated 
over  the  median  line  in  front  of  the  superior  spinous  process  of  the 
third  dorsal  vertebra,  where  a  smooth  spot  appeared.  Treatment  was 
continued  until  the  28th  March  without  much  improvement.     At  that 


Fig.  34. 


date  marked  swelling  appeared  in  front  of  the  wound,  pointing  to 
recurrence  of  necrosis  in  the  supra-spinous  ligament.  We  determined 
not  to  operate  further,  but  to  continue  the  antiseptic  treatment. 

From  the  ist  to  the  15th  April  the  wound  did  not  show  the  slightest 
improvement.  Towards  the  back  for  a  distance  of  about  six  inches 
it  was  healing,  but  the  separation  of  the  skin  and  the  swelling  around 
the  anterior  angle  caused  us  to  fear  that  necrosis  was  extending  in  the 
supra-spinous  ligament. 


356 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


From  the  15th  to  the  30th  treatment  consisted  in  applying  to  the 
necrotic  parts  a  mixture  of  sulphate  of  iron  and  sulphate  of  copper, 
and  in  spraying  the  parts  daily  with  creolin,  followed  by  application  of 
a  dressing  saturated  with  traumatol. 

Under  the  influence  of  the  spray  and  of  the  traumatol,  especially  of 
the  former,  suppuration  diminished,  and  swelling  became  confined  to 
the  right  side.  It  surrounded  an  opening,  at  the  base  of  which  a 
necrotic  fragment  of  the  ligament  could  still  be  seen.  The  parts  were 
again  opened,  allowing  the  spray  to  play  directly  on  the  necrotic 
point,  which  was  cauterised  with  a  mixture  of  the  sulphates  of  iron 


Fig.  35. 


and  copper.  Under  the  action  of  the  2  per  cent,  creolin  and  i  per 
cent,  lysol  spray  the  eschar  separated  in  a  few  days. 

The  wound  finally  granulated  throughout,  and  healing  became 
assured. 

During  the  following  days  suppuration  was  trifling.  Both  wounds 
(Figs.  34  and  35)  made  regular  progress  towards  cicatrisation. 

Remark. — Antiseptic  treatment,  when  thoroughly  carried  out,  often 
gives  good  results  in  the  treatment  of  fistulous  withers,  and  in  fistula 
of  the  neck  and  poll ;  but  even  when  supplemented  by  removal  of 
necrotic  fragments  of  the  supra-spinous  ligament  and  the  cartilaginous 
layer  covering  the  superior  spinous  processes,  recovery  is  frequentl}- 
slow  and  uncertain.  Sometimes  necrosis  has  extended  beyond  the 
limits  of  the  tissue  removed,  especially  in  front  ;  sometimes  the  sup- 
puration which  accompanies  large  operative  wounds  itself  causes 
recurrence.  In  the  case  just  mentioned,  despite  excision  and  the 
observance  of  ordinary  antiseptic  methods,  necrosis  twice  recurred  in 


FRACTURE    OF    THE    FIRST    RIB    IN    THE    HORSE.  357 

front  of  the  wound  within  the  substance  of  the  supra-spinous  hgament. 
It  was  finally  arrested  and  the  wound  rendered  healthy  by  warm  anti- 
septic spraying,  which  has  the  advantage  over  lotions  and  irrigations 
of  penetrating  the  dead  tissue  and  destroying  the  infectious  agents  in 
the  depths. 

ABSCESS    IN    THE    LEFT    COSTAL    REGION— NECROSIS    OF 
THE    LAST    RIB. 

60.  Eleven-year-old  gelding,  left  in  hospital  6th  June,  1896. 

A  year  before  this  horse  had  shown  on  the  left  surface  of  the  chest 
over  the  last  ribs  a  large  swelling,  which  finally  suppurated.  The 
wound  resulting  from  opening  the  abscess  became  sinuous.  The 
animal  having  been  cast  on  the  5th  May  for  castration,  the  veterinary 
surgeon  who  operated  took  advantage  of  the  occasion  to  explore  the 
tract.  The  parts  were  afterwards  irrigated  with  carbolic  solution,  but 
refused  to  heal. 

State  on  Examination.- — On  the  left  side  of  the  chest,  over  the  centre 
of  the  last  rib,  was  a  sharply-defined  swelling,  the  centre  of  which  was 
pierced  by  a  sinuous  tract  running  obliquely  inwards  and  forwards.  A 
probe  penetrated  for  a  distance  of  four  inches. 

The  horse  having  been  cast,  the  sinus  was  laid  open  in  the  axis 
of  the  last  rib,  a  portion  of  which  was  then  seen  to  be  necrotic.  It 
was  resected.  On  passing  the  finger  into  the  wound  the  two  ends 
could  be  felt  about  one  inch  apart.  After  antiseptic  irrigation  of  the 
wound  a  rubber  drainage-tube  was  introduced  and  fixed  to  the  skin 
by  sutures. 

During  the  following  days  the  wound  was  cleansed  and  injected 
with  a  solution  of  iodine  varying  in  strength  between  20  and  30  per 
cent.     Suppuration  was  trifling. 

On  the  15th  the  rubber  tube  was  removed  ;  the  iodine  injections, 
however,  were  continued.  The  wound  was  daily  plugged  with  gauze. 
The  surrounding  tissues  showed  little  swelling. 

On  the  25th  the  deep  portions  of  the  operative  wound  had  to  a  large 
extent  filled  up.  The  plugging  was  discontinued.  From  this  date 
treatment  simply  consisted  in  washing  out  the  wound. 

A  week  later  the  animal  was  returned  to  work.  By  the  end  of  July 
the  wound  had  healed,  and  the  trifling  swelling  which  remained  was 
quite  painless. 

FRACTURE    OF    THE    FIRST    RIB    IN    THE    HORSE. 

61.  Eight-year-old  well-bred  chestnut  mare. 

History. — Had  been  worked  for  three  hours  in  a  victoria  ;  returned 
home  with  great  difliculty  and  exceedingly  lame  in  the  off  fore-leg. 

State  on  Examination. — The  near  fore-heel  showed  signs  of  a  recent 
overreach.  The  animal  was  in  great  pain,  and  supported  the  weight  of 
the  body  mainly  on  the  hind  legs  ;  the  off  fore-leg  was  flexed,  the  knee 
and  fetlock  bent,  and  the  outside  of  the  toe  just  touched  the  ground. 
The  elbow  was  lower  than  normal,  but  was  not  unusually  '*  dropped." 


358 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


By  forcing  the  knee  backwards,  and  thus  straightening  the  leg,  the 
animal  was  enabled  to  take  one  step  with  the  sound  limb ;  but  imme- 
diately the  knee  of  the  injured  limb  became  in  the  least  degree  bent 
the  leg  collapsed,  and  the  animal  nearly  fell.  Progress  was  facilitated 
by  pulling  forward  the  lame  leg  as  far  as  possible,  and 
then  pressing  on  the  knee  until  a  step  had  been  taken 
with  the  sound  leg.  The  most  marked  symptoms 
were  absolute  inability  to  advance  the  leg,  and  great 
difficulty  in  keeping  it  perpendicular.  No  fracture  of 
any  of  the  leg  bones  could  be  distinguished.  Crepitus 
was  entirely  absent. 

Diagnosis. — Fractured  first  rib. 

Prognosis. — Unfavourable  so  far  as  useful  recovery 
was  concerned. 

Treatment. — Slinging  and  rest. 

During  the  three  weeks  and  three  days  the  animal 
was  kept  the  limb  was  always  flexed  and  turned 
slightly  inwards,  so  that  the  outside  toe  of  the  foot 
became  worn. 

Post-niorteni  examination  showed  fractured  first  rib 
(see  Fig.  36)  ;  the  surrounding  muscles  were  not  lace- 
rated or  ruptured.  Only  a  small  provisional  callus 
had  formed.  The  broken  and  overlapped  pieces  of 
bone  were  freely  moveable,  and  not  (as  might  appear 
from  inspection  of  the  figure)  rigidly  fixed  together. 

Mr.  H.  G.  Rogers'  case,  Veterinarian,  1894,  p.  78. 

MYOMA    OF    THE    CESOPHAGUS. 

62.  A  fifteen-year-old  gelding,  brought  for  examina- 
tion on  the  4th  January,  1895. 

A  fortnight  before  a  considerable  swelling  had  been 
noticed  in  the  lower  portion  of  the  jugular  furrow, 
which  the  owner  thought  due  to  collar  pressure. 

During  the  following  days  the  animal  began  to 
roar  as  soon  as  put  to  work.  The  respiration  became 
very  rapid  and  gasping,  so  that  asph3'xia  appeared 
imminent.  When  swallowing  the  food  passed  slowly 
through  the  swollen  region  and  showed  a  tendency  to  stop.  At  certain 
times  a  part  of  the  liquid  taken  was  rejected  through  the  nostrils. 

On  trotting  the  animal  almost  immediately  began  to  roar,  and  the 
swelling  in  the  jugular  region  increased,  dilating  and  contracting 
synchronously  with  the  respiratory  movements. 

Diagnosis. — Tumour  developed  around  and  compressing  the  oeso- 
phagus and  trachea,  or  the  nerves  in  this  region. 

The  lesion  being  principally  thoracic  no  useful  intervention  seemed 
possible,  and  the  animal  was  slaughtered. 

Autopsy. — In  the  lower  third  of  the  neck  the  oesophagus  was  dilated. 
Its  thoracic  portion  was  very  large,  firm,  and  hard,  forming  a  kind  of 
elongated,    fusiform    tumour,    eighteen    inches    in    length    and   ten  in 


Fig.  26- 


CHRONIC    ENDOCARDITIS.  359 

diameter,  weighing  over  twenty-six  pounds.  This  tumour  had  deve- 
loped at  the  expense  of  the  muscular  coat.  Sections  appeared  greyish 
in  colour,  and  exuded  a  milky  pus. 

The  lumen  of  the  oesophagus,  which  was  partly  obstructed  by 
masses  of  food,  was  greatest  opposite  the  centre  of  the  swelling,  and 
gradually  diminished  towards  the  extremities  ;  near  the  cardia  it  was 
reduced  to  very  small  dimensions.  In  the  centre  of  the  swelling  the 
wall  of  the  tube  was  four  inches  in  thickness. 

The  anterior  portion  of  this  growth  had  compressed  and  flattened 
the  bronchi  and  the  last  rings  of  the  trachea,  greatly  diminishing  their 
calibre.  Microscopic  examination  of  the  swelling  showed  it  to  be  a 
myoma  of  unstriped  muscle — leiomyoma. 

CHRONIC    ENDOCARDITIS. 

63.  A  six-year-old  entire  horse,  bought  at  Beauce  on  the  14th 
February,  1897,  and  brought  to  the  School  for  examination  on  the  20th. 

The  day  after  its  arrival  in  Paris  the  animal  had  appeared  dull  and 
tired.  It  was  left  in  the  stable.  It  only  ate  a  small  part  of  its  food. 
A  veterinary  surgeon  who  was  called  in  at  first  regarded  the  case  as 
one  of  pneumonia,  and  prescribed  external  application  of  mustard, 
and  internally  a  mixture,  the  principal  constituents  of  which  were 
tartar  emetic  and  iodide  of  potassium. 

During  the  next  four  days  the  animal  was  not  markedly  worse,  but 
the  symptoms  persisted. 

At  the  first  glance  this  animal  appeared  as  though  suftering  from 
some  pulmonary  disease.  It  was  rather  stiff  and  sleepy,  carried  the 
head  low  with  the  eyes  half  closed  ;  the  conjunctiva  was  moderately 
injected  and  slightly  infiltrated.  The  flank  movements  were  more 
rapid  than  usual,  the  respirations  22  per  minute,  and  expiration  was 
double  ;  the  pulse  was  60,  small  and  irregular. 

We  auscultated  the  chest,  commencing  on  the  right  side.  The 
vesicular  murmur  was  very  feeble,  and  in  certain  parts  of  the  lower  half 
of  the  lung  was  almost  imperceptible  ;  some  borborygmus  was  noted  ; 
the  heart-beats  were  especially  noticeable,  being  unequal  and  irregular 
in  rhythm.  This  at  once  led  us  to  examine  the  heart.  We  noted  a 
strong  systolic  murmur  without  particular  timbre,  which  covered  the 
systolic  sound  and  continued  during  the  short  pause.  Furthermore, 
the  contractions  were  of  irregular  strength,  and  every  three,  four,  or 
five  pulsations  were  followed  by  a  pause,  equal  in  length  to  an  entire 
cardiac  cycle.  Auscultation  of  the  left  lobe  of  the  lung  revealed 
diminished  vesicular  murmur  in  the  lower  half. 

Diagnosis  offered  no  difficulty.  Evidently  this  horse  was  suffering 
from  old-standing  mitral  insufficiency,  complicated  at  that  moment 
with  pulmonary  congestion. 

The  animal  was  rested  for  a  week.  When  brought  back  on  the 
28th  February  the  secondary  troubles  noted  on  the  former  examination 
had  disappeared.  Externally  the  animal  appeared  in  good  health. 
The  respirations  were  only  14  per  minute. 

On  questioning  the  seller  it  was  learned  that  this  horse  had  suffered 
from  strangles  in  October,  1895.     A  month  after  recovery  it  was  used 


360  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

for  farm  work,  and  had  never  shown  any  disturbance  which  could 
have  aroused  suspicion  of  heart  disease  (?).  It  had  never  had  any 
internal  disease  other  than  strangles. 

64.  Sixteen-year-old  gelding,  brought  for  examination  on  the  27th 
March,  1897. 

Was  in  heavy  work.  Between  the  previous  December  and  the 
commencement  of  March  it  had  been  very  hard  worked.  A  month 
before  its  appetite  was  noticed  to  decline,  and  its  condition  to  suffer, 
while  the  limbs  became  greatly  enlarged.  The  horse  was  rested  for 
about  a  fortnight.  On  returning  to  work  it  suffered  from  some  re- 
spiratory disturbance,  and  was  therefore  brought  for  examination. 

The  hind  limbs  were  oedematous,  and  almost  half  as  large  again 
as  normal.  In  addition  to  symptoms  of  acute  bronchitis  we  noted 
very  strong  pulsation  in  the  carotid  and  subzygomatic  arteries. 

On  auscultating  the  heart  the  first  sound  was  heard  to  be  feeble  and 
double  ;  the  second  was  obscured  by  a  murmur  which  continued 
throughout  the  long  pause, — that  is,  by  a  murmur  due  to  aortic  insuf- 
ficiency. All  the  accessible  arteries  exhibited  strong  pulsation.  The 
carotid  and  the  subzygomatic  visibly  rose  at  each  beat  of  the  heart. 

Treatment. — Administration  of  iodide  of  potassium  in  daily  doses 
of  2h  drachms  for  the  first  two  weeks  in  each  month. 

The  horse  still  remained  capable  of  work  until  the  commencement 
of  August.     Shortly  afterwards,  however,  it  had  to  be  slaughtered. 

Autopsy. —  Lesions  of  fibrous  myocarditis.  The  aortic  sigmoid 
valves  were  thickened,  wrinkled,  and  their  faces  irregular.  The  right 
side  of  the  anterior  small  valve  near  the  corpus  Arantii  presented  a 
narrow  perforation  ;  the  lower  surface  of  the  left  side,  close  to  the  free 
border,  was  occupied  by  a  vegetation  as  large  as  a  hempseed.  There 
was  marked  insufficiency,  a  large  space  existing  between  the  valves 
when  approximated. 

The  anterior  lobe  of  the  right  lung  contained  a  patch  of  chronic 
pneumonia, 

65.  A  fifteen-year-old  gelding,  brought  to  the  School  on  the  5th 
June,  i8g8,  to  be  used  as  a  subject  in  the  practical  surgery  class. 

The  animal  was  thin,  emphysematous,  and  a  crib-biter.  On  aus- 
cultating the  heart  a  strong  musical  murmur,  covering  the  second 
sound  and  the  long  pause,  was  heard  over  a  large  surface.  The  first 
heart-sound  was  diminished.  There  was  no  arterial  "dancing."  The 
pulse  was  of  practically  normal  volume. 

At  the  autopsy  the  heart  was  found  to  exhibit  sclerosing  myocar- 
ditis of  both  ventricles  and  changes  in  the  aortic  sigmoid  valves,  which 
were  slightly  thickened  and  showed  several  small  indurated  vegetations. 
Although  the  right  and  left  valves  were  perforated  parallel  to  their  free 
border  insufficiency  was  trifling. 

This  case  shows  once  more  that  a  strong  murmur  due  to  insufficiency 
does  not  necessarily  imply  large  valvular  lesions.  The  character  of  the 
pulse  was  explained  by  the  very  trifling  hiatus,  and  by  the  lesions  of 
the  myocardium. 


MYOCARDITIS — CARDIAC    INTERMITTENCY.  361 


MYOCARDITIS— CARDIAC    INTERMITTENCY. 

66.  Twelve-year-old  gelding,  left  in  hospital  2gth  April,  1896. 
This  horse  had  worked  daily  in  a  brougham  for  several  years,  and 

had  done  good  service.  During  the  months  preceding  entry,  however, 
it  had  been  dull  in  the  stable,  and  for  a  considerable  time  had  refused 
part  of  its  food.  At  work  it  was  "  soft,"  and  carried  its  head  low,  and 
sweated  readily. 

State  on  Examination. — Auscultation  of  the  heart  revealed  intermit- 
tency  ;  the  first  heart-sound  was  of  a  "  rolling  "  character,  and  was 
regarded  as  systolic.  The  pulse  was  full,  strong,  and  numbered  40 
per  minute.  After  a  few  minutes'  trotting  the  heart-beats  became 
violent ;  the  first  sound  was  prolonged,  and  the  second  double. 

Certain  peculiar  symptoms  had  been  noted,  which  appeared  due  to 
brain  mischief.  The  animal  was  almost  always  depressed  and  somno- 
lent. Sometimes  it  walked  in  circles  round  its  box,  sometimes  it 
suddenly  stopped  while  eating.  If  the  front  legs  were  crossed  it 
remained  as  placed  for  some  moments.  It  was  timid  and  very  irritable, 
being  frightened  by  the  slightest  movement  ;  when  ridden  it  would 
often  stop  in  front  of  any  object,  such  as  a  piece  of  paper,  and  refused 
to  proceed.  The  urine  contained  only  traces  of  albumen.  There 
were  no  ocular  lesions. 

Diagnosis. — Chronic  myocarditis,  probably  complicated  by  chronic 
disease  of  the  brain,  dropsy  of  the  lateral  ventricle,  or  tumour  in  the 
choroid  plexus. 

On  the  30th  April,  on  auscultating  the  heart,  intermittencies  were 
noted  lasting  for  a  complete  cardiac  cycle,  and  repeated  after  every 
three  or  four  beats.  One  and  a  half  drachms  of  iodide  of  potassium 
were  given  in  the  drinking-water,  and  the  dose  progressively  increased 
to  2h  drachms.  The  animal's  condition  became  aggravated.  The 
intermittency  grew  longer  and  more  frequent.  On  being  informed 
that  his  horse  was  suffering  from  an  incurable  disease  the  ow^ner  had  it 
slaughtered. 

A  utopsy. — The  heart  was  larger  than  normal,  the  left  ventricle  being 
especially  hypertrophied.  The  walls  of  the  auricles  had  undergone 
hardening.  The  right  ventricle  also  showed  patches  of  sclerosis. 
There  were  no  valvular  lesions. 

The  right  kidney  was  smaller  than  the  left.  Its  surface  showed 
slight  projections  and  depressions,  and  its  capsule  was  more  adherent 
than  normal.  Sections  exhibited  all  the  appearances  of  chronic  atrophic 
nephritis. 

There  was  no  hydrocephalus.  The  plexus  choroides  was  greatly 
thickened,  oedematous,  and  contained  small  cholesteatomata. 

67.  A  ten-year-old  entire  horse,  left  in  hospital  23rd  December, 
1896. 

Three  years  before  it  had  suffered  from  purpura  haemorrhagica. 
After  recovering  it  had  always  worked  well  and  had  shown  no  other 
internal  disease.  During  the  last  few  months  the  animal  had  appeared 
weak,  soon   lost  breath,  and   on  returning  to  the  stable  at  once  lay 


362  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

down.  A  veterinary  surgeon,  who  was  called  in,  was  struck  by  the 
slowness  and  irregularity  of  the  pulse.  He  prescribed  nux  vomica  and 
digitalis.  This  treatment  producing  no  improvement  the  animal  was 
sent  here. 

Condition  on  Entry. — The  conjunctiva  was  pale  ;  the  pulse  was 
feeble,  irregular,  and  intermittent ;  there  was  no  venous  pulse.  On 
auscultating  the  heart  pauses  were  noted  after  every  third  or  fourth 
pulsation.  They  lasted  for  a  period  equal  to  one  or  two  complete  heart 
cycles.     Furthermore,  the  first  beat  of  the  heart  was  double. 

Treatment. — Iodide  of  potassium  in  daily  doses  of  2^  drachms. 
Appetite  was  preserved,  and  the  animal  ate  freely. 

On  the  i6th  December  examination  of  the  heart  and  pulse  revealed 
no  change.  After  a  few  moments'  trotting  the  heart-beats  became 
accelerated  and  violent,  and  the  pauses,  which  at  rest  had  occurred 
after  every  third  or  fourth  pulsation,  were  deferred  for  much  longer 
intervals.  Their  duration  still  equalled  that  of  a  complete  heart  cycle. 
The  first  pulsation  which  followed  an  intermittence  was  stronger  than 
the  others.  The  pulse  was  small  and  feeble,  contrasting  with  the 
violence  of  the  heart-beats. 

After  some  minutes'  rest  the  intermittency  resumed  its  previous  fre- 
quence.    During  the  next  few  days  the  condition  remained  stationary. 

The  animal  left  hospital  on  the  gth  January.  Treatment  had  pro- 
duced no  improvement,  but  the  owner  was  advised  to  continue  it  for 
fourteen  days  each  month. 

68.  A  three-year-old  mare,  brought  for  examination  on  the  14th 
December,  1895. 

The  animal  had  been  bought  a  week  before  at  a  cab  sale.  In  work 
it  rapidly  lost  breath,  slackened  its  pace,  and  stopped,  showing  signs 
of  violent  dyspnoea.  The  neck  was  extended ;  the  face  appeared 
anxious  ;  respiration  was  very  rapid,  and  the  flank  movements  were 
short  and  irregular. 

At  the  first  examination,  made  after  a  period  of  rest,  breathing  was 
regular.  There  was  no  double  flank  movement  and  no  check  during 
expiration.  The  cough  was  not  like  that  of  broken  wind.  The  pulse 
was  irregular,  a  series  of  three  or  four  normal  pulsations  being  followed 
by  a  feeble  beat.  On  auscultating  the  heart  no  murmur  and  no  change 
in  the  sounds  could  be  detected,  but  the  rhythm  was  not  quite  regular, 
three  or  four  normal  beats  being  followed  by  a  slower  and  feebler  con- 
traction. 

After  a  few  minutes'  trotting  the  heart  beat  violently  and  irregularly  ; 
the  second  sound  was  diminished  and  almost  lost,  but  the  irregularity 
of  the  pulse  was  less  marked.  At  the  end  of  about  two  minutes  pauses 
could  be  detected  approximately  equal  in  duration  to  two  cardiac 
cycles  ;  these  were  followed  by  two  slow,  and  afterwards  by  four  or  five 
rapid  contractions  ;  beats  then  succeeded  in  increasingly  rapid  succes- 
sion until  the  next  pause.  The  pulse  showed  some  want  of  rhythm. 
At  the  end  of  ten  minutes  intermittency  had  disappeared,  and  all  that 
could  be  detected  was  irregularity  in  the  strength  of  the  cardiac  con- 
tractions and  pulse. 


MYOCARDITIS — CARDIAC    INTERMITTP:NCY.  363 

On  again  exercising  the  horse  the  same  pecuharities  were  noted. 
The  intermittency  recurred  two  or  three  minutes  after  exercise  was 
stopped,  and  again  disappeared  some  minutes  later. 

6g.  A  ten-year-old  gelding,  brought  for  examination  on  the  i6th 
January,  1896. 

Had  been  in  the  hands  of  the  same  owner  during  four  years,  doing 
regular  work  delivering  parcels,  sometimes  at  a  walk,  sometimes  at  a 
trot.  Had  been  healthy  for  that  period.  Both  at  work  and  in  the 
stable  this  horse  coughed  rather  frequenth*.  A  month  before  examina- 
tion it  began  rapidly  to  lose  breath,  and  to  cough  more  than  usual. 

The  patient  was  emphysematous.  It  showed  a  distinctly  double 
flank  movement,  and  had  a  short,  dry,  paroxysmal  cough.  Ausculta- 
tion of  the  lungs  revealed  sibilant  rales  and  a  dry  crepitant  sound  On 
auscultating  the  heart,  every  fourth  or  fifth  contraction  was  followed 
by  a  pause  equal  in  length  to  two  cardiac  cycles.  The  pulse  showed 
similar  characters. 

This  intermittenc\'  disappeared  during  exercise,  but  returned  after 
a  few  minutes'  rest. 

Iodide  of  potassium  and  arsenical  preparations  were  prescribed,  to 
be  continued  for  a  week  and  interrupted  for  a  similar  period. 

70.  A  seven-year-old  entire  horse,  left  in  hospital  31st  July,  1897. 
Three  weeks  before  had  been  attacked  with  pneumonia,  which  had 

not  been  detected  until  in  an  advanced  stage,  and  had  left  troubles 
regarded  as  due  to  heart  disease. 

On  entry  the  animal's  general  condition  was  satisfactory.  There 
were  no  visible  signs  of  disease.  Respiration  was  normal.  The  pulse 
was  rapid,  small,  and  intermittent.  On  auscultating  the  heart  the  first 
sound  was  double,  the  second  diminished,  and  pauses  occurred  after 
ever}-  sixth  or  eighth  normal  contraction,  each  pause  lasting  as  long  as 
a  complete  heart  cycle. 

Treatment. — Iodide  of  potassium  in  2 i -drachm  doses  daily,  gradu- 
all)'  increased  by  the  end  of  a  week  to  4  drachms. 

During  the  following  days  intermittency  persisted  with  the  same 
characters.  After  the  loth  August  the  pauses  occurred  at  longer  and 
less  regular  intervals.  On  the  20th  August,  when  the  animal  left 
hospital,  they  onl)' occurred  after  every  fifteenth  to  twentieth  pulsation. 

71.  A  six-year-old  gelding,  left  in  hospital  7th  December,  1897. 
Had  been   worked  very  hard.     Three  days  before,  when  sweating 

freely,  had  been  exposed  to  rain  for  more  than  an  hour.  That  evening 
the  animal  refused  food.  A  veterinary  surgeon  who  examined  it 
prescribed  treatment.  The  animal  was  brought  here  on  the  morning 
of  the  succeeding  day.  The  temperature  was  then  40*5'^  C,  the  con- 
junctiva yellowy  the  eyes  half  closed  ;  the  nostrils  discharged  a  little 
rusty-coloured  mucus  ;  the  lower  third  of  the  chest  was  dull,  the  right 
side  revealed  moist  crepitation  ;  the  pulse  was  large  and  strong,  56  per 
minute ;  respirations  were  22  per  minute. 
Diagnosis — Pneumonia. 


364  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

Treatment. — Bleeding,  sinapisms,  5  ounces  of  alcohol,  mashes  and 
milk. 

Next  day  the  temperature  was  39*9*^  C,  respirations  30,  pulse  63. 
The  animal  was  depressed  and  sleepy.  Nevertheless  it  took  milk  and 
hay  tea,  to  which  alcohol  had  been  added. 

On  the  9th  a  tubal  murmur  could  be  heard  on  the  right  side.  The 
heart-beats  were  violent  and  audible  on  either  side.  Temperature  40*7° 
C,  pulse  64,  respirations  32.  Sulphate  and  bicarbonate  of  soda  were 
further  prescribed. 

On  the  loth  and  nth  the  animal  was  more  depressed  ;  it  could 
scarcely  stand,  and  appeared  as  though  suffering  from  laminitis  in  the 
fore-feet. 

On  the  1 2th  these  signs  of  weakness  and  of  congestion  about  the 
feet  had  disappeared.  The  pneumonia  was  undergoing  resolution.  A 
moist  crepitant  rale  could  be  heard.     Temperature  38'5°  C. 

On  the  13th  the  heart  became  intermittent,  pauses  occurring  after 
series  of  four  to  twelve  contractions.     All  treatment  was  stopped. 

On  the  14th  intermittency  was  more  frequent.  Of  five  pauses,  four 
usually  occurred  after  a  regular  series  of  four  pulsations,  the  fifth  after 
an  irregular  series  of  two  to  eight. 

On  the  1 6th  the  pauses  were  less  numerous.  They  became  less  and 
less  frequent  until  the  animal  left  hospital. 

TAn  interesting  contribution  to  the  study  of  heart  disease  in  the 
horse,  by  Professor  Stockman,  appears  in  the  Journal  of  Comparative 
Pathology  and  Therapeutics  for  1894,  p.  138.] 

HYDATID  CYST  OF  THE  HEART. 

72.  An  eight-year-old  Percheron  gelding,  which  had  died  suddenly 
during  work  on  the  9th  August,  1893.  The  autopsy  was  incomplete, 
but  the  heart  was  sent  to  us  as  it  exhibited  peculi'ar  changes. 

It  was  of  large  size,  and  towards  the  centre  of  the  left  ventricular 
wall  showed  a  swelling  as  large  as  a  turkey's  Q^g,  yellowish  white  in 
colour,  the  surface  marked — especially  towards  the  periphery — with 
fine  vascular  branchings.  The  swelling  was  uniform,  fluctuating,  and 
thin-walled. 

Incision  gave  exit  to  a  serous  liquid  containing  in  suspension  a  few 
whitish  flocculi.  Though  for  the  most  part  smooth,  the  wall  of  the  cyst 
was  irregular  in  places,  marked  with  slight  depressions  and  promi- 
nences. Microscopic  examination  of  a  scraping  from  the  internal  surface 
showed  scolices  and  numerous  hooks.  The  wall  was  formed  of  two 
distinct  membranes  somewhat  loosely  united  :  the  external,  forming 
the  hydatid  membrane  or  cuticle,  exhibited  a  number  of  caseating  and 
calcified  patches ;  the  internal,  or  germinal  membrane,  was  greyish  in 
colour,  thin,  and  very  delicate. 

The  cyst  measured  three  inches  and  a  half  in  greatest  length,  and 
two  inches  and  three  quarters  to  three  inches  in  diameter.  It  pro- 
jected above  the  surface  of  the  ventricle  to  the  extent  of  more  than  an 
inch.  Two  thirds  of  the  thickness  of  the  wall  of  the  ventricle  were 
destroyed,  so  that  the  muscular  tissue,  which  should  have  been  nearly 


FOREIGN    BODY    IN    THE    PERICARDIUM.  365 

two  inches  in  thickness  opposite  the  centre  of  the  swelHng,  was  reduced 
to  about  half  an  inch. 

INTRA-MURAL    CARDIAC    ABSCESS    IN    A    COW. 

73.  History. — About  a  year  previous  to  death  the  animal  had 
suffered  from  "  foul  in  the  foot "  with  fever  ;  the  foot  had  not  perfectly 
healed  until  after  three  months.  A  week  before  death,  which  occurred 
very  suddenly,  the  cow  had  shown  trifling  symptoms.  It  had  not  been 
treated. 

Post-mortem  examination  showed  all  the  internal  organs  except  the 
heart  to  be  healthy.  Projecting  from  the  ventricular  septum  into 
the  right  ventricle  was  an  eminence  the  shape  of  an  English  cottage 
loaf,  measuring  three  inches  in  diameter  by  two  in  depth  from  its 
summit  to  the  level  of  the  ventricular  surface  of  the  septum.  The 
endocardium  had  become  softened  and  entirely  removed  from  its 
salient  parts  by  the  current  of  blood,  and  was  replaced  by  several 
layers  of  coagulated  lymph.  On  incising  this  fluctuating  swelling, 
thick,  creamy,  odourless  pus  escaped,  leaving  a  very  large  cavity  in  the 
substance  of  the  septum,  which,  however,  was  intact  on  the  side  of  the 
left  ventricle.  There  was  slight  hypertrophy,  but  the  walls  of  the  heart 
and  the  valves  were  otherwise  healthy. 

Note. — Professor  Walley  regarded  the  abscess  as  pya^mic  in  origin, 
and  consequent  on  the  above-mentioned  attack  of  "  foul  in  the  foot." 
Death  was  probably  due  to  syncope. 

Prof.  Walley's  case,  Joiirn.  Comp.  Path,  and  Therap.,  1894,  p.  65. 

FOREIGN    BODY    IN    THE    PERICARDIUM— INTRA-PERICARDIAL 
HEMORRHAGE. 

74.  On  the  6th  June,  1892,  a  cowkeeper  in  the  neighbourhood 
brought  us  the  body  of  a  cow  which  had  died  during  the  night,  without 
having  previously  shown  any  signs  of  grave  disease. 

Post-mortem  examination  proved  that  the  animal  had  died  from  intra- 
pericardial  haemorrhage  produced  by  a  fragment  of  iron  wire.  This 
fragment,  starting  from  the  reticulum,  had  pierced  its  anterior  wall, 
passed  through  the  diaphragm,  penetrated  the  pericardium,  and  at- 
tained the  heart  opposite  the  posterior  vascular  furrow,  an  inch  or  two 
from  the  point,  the  sharp  extremity  as  usual  being  in  front. 

The  foreign  body  having,  as  commonly  happens,  produced  chronic 
inflammatory  lesions  in  the  tissues  traversed,  there  is  some  room  for 
doubting  the  extreme  suddenness  of  death  and  the  absence  of  more  or 
less  grave  premonitory  disturbance,  either  of  continued  or  intermittent 
character,  during  the  days  preceding  the  end. 

Questioned  on  this  point,  the  owner  gave  the  following  very  precise 
information  : — "  I  purchased  this  cow  on  the  22nd  January  last.  Apart 
from  a  trifling  ailment  lasting  for  a  few  hours,  which  she  showed  soon 
after  arrival,  her  soundness  never  appeared  doubtful.  One  thing,  how- 
ever, struck  me.  Although  she  showed  excellent  appetite  this  beast 
never  grew  fat,  but  this  I  attributed  to  the  fact  that  she  was  a  very 
good  milker.     On  the  evening  before  the  day  of  death  I  passed  through 


366  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

the  stable  as  usual  about  ten  o'clock,  and  she  then  seemed  to  me  to  be 
ruminating  like  the  others.  At  any  rate  I  noticed  nothing  remarkable, 
and  at  six  o'clock  next  morning  she  gave  the  same  quantity  of  milk  as 
on  the  preceding  days.  Next  morning  she  was  found  dead.  As  to  the 
swallowing  of  some  sharp  body,  or  the  cause  of  death  itself,  the  expla- 
nation is  as  follows : — At  the  beginning  of  February  I  received  from 
Brittany  some  hay  in  bales  fastened  with  iron  wire.  A  fragment  of 
this  wire  must  have  fallen  into  the  food  given  to  this  animal  and  have 
been  swallowed." 

As  none  of  this  hay  had  been  used  after  the  first  week  of  March,  the 
fragment  of  wire  had  remained  for  about  three  months  in  the  stomach 
and  in  the  tissues  it  had  traversed  before  producing  fatal  results. 

RUPTURE    OF    THE    RIGHT    VENTRICLE    IN    THE    HORSE. 

75.  A  five-year-old  well-nourished  brown  cart  gelding,  16.2  hands 
high. 

History. — Had  recently  been  purchased  and  only  worked  for  a  fort- 
night. On  the  ist  July,  1896,  had  made  a  long  journey  involving 
much  hill  climbing  ;  arrived  at  its  destination,  the  animal  had  to  draw 
and  back  through  new-made  ground.  It  suddenly  plunged,  fell,  gave 
a  few  convulsive  struggles,  and  died. 

Autopsy. — The  right  side  of  the  thoracic  wall  was  wounded  over 
the  ninth  rib  by  the  broken  shaft,  but  the  chest  cavity  was  not  pene- 
trated. Abdominal  organs  healthy.  Right  lung  hypostatically  con- 
gested, but  lungs  otherwise  normal.  The  pericardium  was  distended 
with  blood.  On  cautiously  incising  it  and  examining  the  heart  three 
ruptures  were  found  in  the  wall  of  the  right  ventricle ;  the  first,  about 
two  and  a  half  inches  in  length,  situated  almost  centrally  in  the  wall 
of  the  ventricle,  was  irregularly  funnel-shaped,  being  large  externally, 
and  tapering  down  to  an  aperture  about  three  quarters  of  an  inch 
across,  communicating  with  the  interior  of  the  ventricle.  The  muscular 
fibres  were  not  shredded,  but  showed  a  comparatively  "short"  frac- 
ture. The  second  wound  resembled  the  first,  was  two  inches  from 
the  apex  of  the  heart,  about  three  quarters  of  an  inch  in  length,  and 
communicated  with  the  ventricle  by  a  mere  point.  The  third  was 
about  one  eighth  inch  across  and  a  quarter  of  an  inch  in  depth  ;  it 
lay  half  an  inch  from  the  apex  of  the  heart,  but  did  not  communicate 
with  the  ventricle.  Measured  at  their  thinnest  points  the  thickness 
of  the  walls  of  the  various  heart  cavities  was  as  follows  :  —  Right  auricle 
five  sixteenths  of  an  inch  ;  left  auricle  (close  to  junction  with  ventricle) 
two  inches  ;  right  ventricle  five  eighths  of  an  inch  ;  left  ventricle  (near 
auricle)  two  and  three  eighths  inches  ;  near  apex  of  heart  one  and  a 
quarter  inches  ;  septum  one  and  seven  eighths  inches. 

Mr.  Jno.  A.  W.  Dollar's  case,  Veterinarian,  1896,  p.  670. 

RUPTURE    OF    THE    PULMONARY    ARTERY. 

76.  A  two-year-old  Irish  setter,  bought  when  five  weeks  old. 
At  the  age  of  ten  months  had  suffered  from  severe  distemper,  but 
had  completely  recovered,  and  afterwards  enjoyed  good  health. 


RUPTURE    OF    THE    PULMONARY    ARTERY.  367 

About  three  in  the  afternoon  of  the  2nd  March,  1895,  it  was  playing 
with  another  dog  in  front  of  its  master's  house,  when  suddenly  it  began 
running  as  though  mad,  leaped  upwards  several  times,  and  fell  dead. 
Poisoning  being  suspected,  the  cadaver  was  sent  to  the  College. 

Autopsy. — Extreme  pallor  of  the  visible  mucous  membranes.  The 
spleen  was  large,  and  of  the  lilac  tint  common  in  lymphadenoma.  The 
liver  had  undergone  a  certain  degree  of  hypertrophy. 

Lungs  normal.  The  pericardium  was  considerably  distended  with 
blood.  The  organs  about  the  base  of  the  heart,  the  large  vessels 
originating  there,  and  the  trachea,  were  covered  with  a  layer  of  coagu- 
lated blood,  infiltrated  between  the  layers  of  the  mediastinum. 

On  opening  the  pericardium  a  little  red  blood  escaped.  The  cavity 
contained  a  thick  clot  moulded  on  the  heart.  Over  the  origin  of  the 
great  arterial  vessels  the  visceral  layer  presented  a  rupture  about  three 
eighths  of  an  inch  in  length. 

The  heart  was  carefully  examined,  but  neither  ventricles,  auricles, 
nor  valves  showed  anything  abnormal. 

The  external  surface  of  the  pulmonary  artery  was  covered  with  a 
thick  clot.  On  removing  this  we  detected  on  the  right  surface  of  the 
vessel,  about  three  eighths  of  an  inch  from  the  base  of  the  heart,  two 
transverse  ruptures,  one  measuring  a  quarter  of  an  inch,  the  other  one 
eighth  of  an  inch  in  length.  Opposite  these  tears  the  artery  was  ex- 
tremely thin,  and  showed  several  little  atheromatous  points.  Escaping 
by  these  ruptures  the  blood  had  spread  around  the  large  vessels,  thrust 
apart  the  layers  of  the  mediastinum,  lifted  the  visceral  layer  of  the 
pericardium,  which  became  ruptured  under  the  pressure,  and  then  by 
accumulating  in  the  pericardial  sac  produced  cardiac  syncope  and 
death. 


IV.— ABDOMEN    AND    TAIL. 

NECROSIS    OF    APONEUROTIC    TISSUES    IN    THE    FLANK. 
77.  A  twelve-year-old  gelding,  left  in  hospital  the  5th  February, 

Two  months  before  this  horse  had  suffered  from  colic  and  intestinal 
indigestion,  for  which  the  caecum  was  punctured.  During  the  follow- 
ing days  a  warm,  painful,  oedematous  swelling  developed  around  the 
wound,  but  nevertheless  the  horse  continued  to  work  for  some  time. 
As  the  wound  became  sinuous,  suppurated  freely,  and  resisted  treat- 
ment by  antiseptic  injections,  the  animal  was  sent  to  Alfort. 

The  centre  of  the  right  flank  displayed  a  granulating  wound,  nearly 
an  inch  in  diameter,  surrounded  by  induration  which  extended  as  far 
as  the  last  rib.     The  pus  was  abundant,  liquid,  and  offensive. 

Diagnosis. — Necrosis  of  aponeurotic  tissues  in  the  flank. 

The  horse  was  cast  on  the  table.  The  sinus  was  found  to  be  about 
six  inches  in  length,  penetrated  deeply,  and  ended  in  a  large  blind 
pouch.  It  was  exposed,  a  counter-opening  made  at  the  lowest  point, 
and  a  rubber  drainage-tube  inserted.  The  sinus  was  frequenth'  washed 
out  with  creolin  and  sublimate  solution. 

By  the  20th  February  swelling  and  suppuration  had  markedly 
diminished,  and  the  animal  seemed  in  a  fair  way  to  recovery.  A  week 
later,  however,  swelling  extended  below  the  lower  wound,  from  which 
pus  escaped  freely.  Fresh  operation  was  decided  on.  On  probing 
the  lower  wound  a  sinus,  four  inches  in  length,  was  found  running 
obliquely  downwards  and  slightly  backwards,  along  the  last  rib.  A 
counter-opening  was  made,  and  this  second  sinus  drained  like  the 
former.  The  injections  were  continued,  though  the  liquids  used  and 
the  degree  of  concentration  were  varied.  Among  others,  carbolic  acid, 
sublimate,  chloride  of  zinc,  Villate's  solution,  and  tincture  of  iodine 
were  tried.  A  20  to  30  per  cent,  solution  of  tincture  of  iodine  and 
iodide  of  potassium  was  found  most  useful. 

Recovery  was  not  complete  until  towards  the  15th  Jime,  though  had 
the  animal  not  been  used  in  a  carriage  it  might  long  before  have  been 
returned  to  work. 

Remark. — Although  the  disease  was  remarkabl}-  obstinate  we  did 
not  think  it  advisable  to  perform  a  radical  operation,  as  this  would 
have  necessitated  too  great  destruction  of  tissue  and  would  not  have 
been  without  danger,  on  account  of  the  depth  to  which  the  sinus 
extended  into  the  abdominal  wall.  We  therefore  preferred  to  confine 
ourselves  to  counter-openings,  drainage,  and  antiseptic  injections. 


369 


HERNIA. 


78,  A  cart  stallion  brought  to  the  external  clinique  on  the  14th 
June,  i8g8. 

A  few  hours  before,  when  working  in  a  dray,  one  of  the  arms  of  the 
windlass  *  had  penetrated  the  left  flank. 

A  large  oedematous  swelling  was  visible  in  the  left  flank  opposite 
the  stifle.  On  manipulation,  the  abdominal  tunic  was  discovered  to  be 
ruptured,  and  slightly  above  this  rupture  the  muscles  were  torn 
through.  In  order  to  confirm  the  diagnosis  (of  ventral  hernia)  the 
parts  were  explored  per  rectum.  Four  to  five  inches  in  front  of  the 
inguinal  ring  was  a  tear  about  six  inches  long  in  the  abdominal  wall, 
running  obliquely  forwards  and  outwards. 

During  the  afternoon  the  animal  was  cast  on  the  right  side  and 
chloroformed;  the  left  hind  leg  was  abducted,  as  in  operation  for 
strangulated  inguinal  hernia.  After  disinfecting  the  parts,  M.  Almy 
made  an  incision  about  six  inches  in  length  through  the  skin,  in  an 
oblique  direction  backwards  and  inwards,  exposing  a  loop  of  slightly 
congested  small  intestine.  This  having  been  reduced,  the  muscles  and 
aponeuroses  forming  the  abdominal  wall  were  seen  to  be  irregularly 
torn,  the  several  layers  being  ruptured  in  different  directions.  The 
muscular  tissues  were  brought  together  with  a  line  of  silk  sutures,  which, 
however,  were  very  difficult  to  insert  on  account  of  the  condition  of  the 
tissues.  A  second  row  of  silk  sutures,  crossing  the  former  in  an 
oblique  direction,  was  inserted  in  the  aponeurotic  portion  ;  lastly,  the 
skin  was  brought  together.     A  cotton-wool  dressing  was  applied. 

After  removal  of  the  hobbles  the  patient  remained  recumbent,  not 
rising  until  the  end  of  a  couple  of  hours.  Food  was  confined  to  gruel 
and  milk.  The  evening  temperature  was  38"8°  C,  respirations  16, 
pulse  50. 

During  the  three  following  days  the  temperature  oscillated  between 
38*8°  C.  and  397°  C.  A  considerable  oedematous  swelling  developed 
around  the  wound. 

Between  the  17th  and  20th  the  temperature  rose  to  39-'  C,  some- 
times even  to  39*5^  C,  and  the  respirations  became  more  frequent — 
45  to  50  per  minute. 

On  the  20th  the  wound,  after  cleansing,  was  bright  red,  and  almost 
entirely  covered  with  granulations.  A  few  small  fragments  of  the 
aponeurosis,  which  had  become  loose,  were  excised.  Some  of  the  deep 
sutures  were  removed,  the  parts  were  dusted  with  iodoform,  and  a 
gauze  dressing  applied.  Fever  continued  distinctly  high,  respiration 
was  rapid  and  shallow. 

From  the  22nd  to  the  25th  general  disturbance  diminished.  The 
patient  consumed  all  its  food.  On  the  30th  June  it  left  hospital  in  a 
fair  way  to  recovery. 

When  again  seen  on  the  gth  July  the  wound  had  healed,  and  the 
swelling  disappeared  ;  the  hernia  was  cured. 

*  In  France  carts  used  for  carrying  casks  are  provided  with  a  windlass  for  tightening 
the  ropes  by  which  the  load  is  secured. — Jno.  A.  W.-  D. 

A  A 


370  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

79.  A  five-year-old  entire  horse,  brought  to  the  school  on  the  5th 
March,  1895.     Since  the  previous  night  it  had  suffered  from  colic. 

Examination  of  the  upper  inguinal  rings  left  no  doubt  as  to  the 
origin  of  the  abdominal  pain,  which  was  due  to  acute  left-sided  inguinal 
hernia. 

The  animal  having  been  cast  and  suitably  secured  was  anaesthetised 
with  ether,  the  scrotum  was  disinfected,  and  operation  performed.  On 
enucleating  the  cord,  the  deep  tissues  (cremasteric  fascia  and  tunica 
vaginalis)  w^ere  found  torn  through  externally  for  a  distance  of  three  to 
three  and  a  half  inches.  Having  incised  the  vaginal  sheath  along  the 
lower  margin  of  the  testicle,  strangulation  was  seen  to  have  taken 
place  at  the  hernial  ring,  which  was  situated  opposite  the  external 
inguinal  ring  at  a  much  lower  point  than  usual.  The  hernial  swelling 
was  composed  of  two  parts.  The  first,  above  the  hernial  ring,  was 
rather  larger  than  a  man's  fist,  formed  by  a  portion  of  intestine  which 
had  thrust  aside  the  vaginal  tunic  and  drawn  the  peritoneum  through 
the  internal  inguinal  ring,  the  anterior  margin  of  which  was  torn.  In 
the  other  part,  situated  below  the  hernial  ring,  the  intestine  had  already 
undergone  grave  change,  was  blackish  in  colour,  and  in  imminent  danger 
of  becoming  gangrenous.  It  was  rinsed  with  boiled  salt  solution. 
After  enlarging  the  hernial  ring  by  incision  in  an  outward  direction 
reduction  was  easy,  A  little  hesitation  was  felt  as  to  the  best  method  of 
fixing  the  clamps,  but  it  was  finally  decided,  after  torsion  of  the  vaginal 
sheath,  to  apply  them  to  the  cord  and  skin.  This  method  was  preferred, 
firstly,  as  insuring  against  further  protrusion  of  intestine,  rendered 
possible  by  tearing  of  the  vaginal  sheath,  and  favoured  by  patency  of 
the  inguinal  ring  ;  and  secondly,  as  favouring  adhesion  of  the  skin  to 
the  cord  below  the  ring,  and  thus  ensuring  formation  of  a  solid  fibrous 
cicatrix. 

The  operative  wound  progressed  favourably,  but  the  herniated 
portion  of  the  intestine  became  gangrenous,  and  death  occurred  on  the 
sixth  day. 

It  is  easy  to  explain  the  symptoms  shown  by  this  case.  The  hernia 
presented  two  conditions  of  different  age  and  character.  The  internal 
inguinal  ring  had  been  abnormally  large  before  strangulation  ;  the 
peritoneum  surrounding  it  had  yielded  under  the  continual  tension, 
and  a  loop  of  intestine  had  become  extruded,  forming  a  hernial  swelling 
in  the  depth  of  the  groin.  This  swelling  afterwards  became  compli- 
cated with  acute  inguinal  hernia.  Tearing  of  the  vaginal  sheath 
probably  resulted  from  the  repeated  manipulation  to  which  the  scrotum 
had  been  subjected  before  operation. 

80.  A  five-year-old  setter  bitch,  left  in  hospital  15th  March,  1893. 
This  animal  had  long  suffered  from  inguinal  hernia,  which,  however, 

had  gradually  increased  in  size  during  the  preceding  months.    On  entry 
it  was  incommoded  by  the  swelling,  and  sometimes  appeared  in  pain. 

The  swelling  occupied  the  left  inguinal  region,  and  was  the  size  of 
a  man's  fist.  Though  tense  when  the  animal  was  standing,  it  imme- 
diately diminished  and  became  flaccid  when  the  animal  was  placed  in 
the  dorsal  position  and  taxis  performed.     It  was  perfectly  reducible. 


HERNI/E.  371 

For  three  days  the  patient  was  placed  on  milk  diet  and  received  one 
third  grain  of  calomel  daily. 

Operation. — On  the  gth  March  the  bitch  was  secured  in  the  dorsal 
position.     Anaesthetics  were  not  given. 

The  skin  covering  the  swelling  and  surrounding  parts  was  washed 
with  soap,  shaved,  and  rinsed  with  alcohol  and  sublimate  solution. 
The  flanks  and  abdomen  were  covered  with  aseptic  compresses.  An 
incision  about  three  and  a  half  inches  in  length  was  then  made  through 
the  skin  in  the  long  axis  of  the  swelling,  running  in  a  slightly  oblique 
direction  backwards  and  inwards.  The  sac  was  enucleated  with  the 
fingers,  care  being  taken  not  to  tear  it.  By  methodical  compression 
over  the  exposed  part  of  the  sac  the  contained  organs  were  gradually 
returned  to  the  abdomen.  The  hernial  opening,  formed  by  the  enlarged 
inguinal  ring,  was  oval  in  form  ;  it  measured  about  three  quarters  of  an 
inch  in  its  longer  diameter  and  three  eighths  of  an  inch  across.  The 
sac  was  twisted  under  slight  tension,  ligatured  with  silk  as  close  as 
possible  to  the  inguinal  ring,  and  the  free  part  removed  about  one  sixth 
of  an  inch  below  the  ligature.  After  slightly  curetting  the  margins  of 
the  inguinal  opening  the  lips  were  touched  with  strong  carbolic  solution 
and  brought  together  with  two  silk  ligatures.  The  wound  was  cleansed 
with  tampons  of  cotton  wool,  powdered  with  iodoform,  and  the  skin 
brought  together  with  interrupted  sutures.  When  dried  the  sutures 
were  covered  with  a  layer  of  iodoform  collodion.  The  ingumal  region 
was  surrounded  with  a  gauze  compress  and  enveloped  in  a  thick  layer 
of  cotton  wool  put  in  place  by  a  bandage. 

No  bad  results  followed.  During  the  succeeding  night  and  next 
two  days  the  animal  was  fed  on  milk  and  meat.  The  temperature 
never  exceeded  39*4°  C. 

On  the  nth  March  the  dressing  was  removed.  The  margins  of  the 
wound  were  slightly  swollen  ;  there  was  no  suppuration. 

On  the  i6th  the  wound  had  healed  to  a  very  large  extent ;  its  centre, 
and  about  one  and  a  quarter  inches  of  its  lips,  discharged  a  little  sero- 
sanguinolent  fluid.  It  was  cleansed  with  carbolic  solution  and  the 
cutaneous  sutures  removed.  The  parts  were  swabbed  with  a  cotton- 
wool tampon  saturated  in  alcohol,  a  new  dressing  of  cotton  wool  was 
applied  and  left  in  position  until  the  20th.  At  that  date  the  centre 
portion  of  the  wound  had  healed.     The  animal  left  on  the  25th. 

Remarks. — Operation  for  acute  inguinal  hernia  in  the  bitch  is  some- 
times difficult  owing  either  to  adhesion  between  the  herniated  organs 
and  the  sac,  or  to  the  presence  of  a  foetus  in  one  of  the  (herniated) 
uterine  horns.  When  one  of  the  herniated  organs  is  adherent  to  the 
sac  the  latter  is  incised,  the  adhesion  broken  down,  the  hernia  reduced, 
and  operation  concluded  as  usual.  When,  however,  epiploon  alone  is 
contained  in  the  sac  the  latter  is  either  ligatured  with  catgut  and 
excised,  or  traction  is  exercised  on  the  sac,  which  is  ligatured  as  high 
as  possible  and  resected,  together  with  its  contents. 

At  the  present  moment  we  have  in  hospital  a  St.  Germain  setter  bitch 
operated  on  for  left  inguinal  hernia,  in  which  the  sac  contained  both 
uterine  horns  and  a  large  mass  of  epiploon.  The  removal  of  these  parts 
necessitated  triple  ligation  ;  nevertheless,  recovery  was  uncomplicated. 


372  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

When  the  sac  contains  a  horn  of  the  gravid  uterus  it  is  freely  opened 
and  hgatures  appHed  to  the  pedicle  of  the  ovary,  the  base  of  the  horn, 
and  the  corresponding  half  of  the  broad  ligament,  and  drawn  thoroughly 
tight,  the  parts  being  excised  four  inches  below  the  ligatures.  Before 
returning  the  stump  of  the  horn  the  mucous  membrane  is  scraped  and 
disinfected  with  strong  carbolic  solution. 

Wherever  asepsis  appears  doubtful,  a  drainage-tube  or  strip  of  gauze 
should  be  inserted  and  sutured  to  the  skin  to  allow  of  discharges 
escaping. 

8i.  A  two-year-old  Danish  dog,  left  in  hospital  14th  October,  1894. 

Three  months  before  a  hot,  cedematous,  painful  swelling  was  noted 
on  the  lower  surface  of  the  abdomen,  immediately  in  front  of  the  right 
stifle,  accompanied  by  lameness  in  the  right  hind  leg.  Swelling  and 
pain  disappeared  in  the  course  of  a  week.  The  dog  was  suffering  from 
ventral  hernia. 

Condition  on  Entry. — In  the  lower  portion  of  the  right  flank,  slightly 
in  front  of  the  stifle,  was  an  ovoid  swelling,  the  size  of  an  egg,  painless, 
uniformly  fluctuating,  and  readily  reducible. 

The  animal  having  been  placed  on  its  back  one  could,  after  reduction, 
pass  the  end  of  the  index  finger  into  the  hernial  opening,  which  was  of 
considerable  size  and  elliptical  in  form.  The  animal  was  prepared  as  in 
the  preceding  cases,  and  operation  was  performed  on  the  18th  October 
under  chloroform. 

The  skin  having  been  disinfected,  an  incision  about  three  to  three 
and  a  half  inches  in  length  was  made  over  the  long  axis  of  the  tumour, 
in  a  slightly  oblique  direction,  downwards  and  inwards,  and  the  sac 
enucleated.  Whilst  an  assistant  exercised  slight  traction  on  the  sac,  a 
double  catgut  ligature  was  passed  around  it,  level  with  the  opening, 
drawn  tight,  the  two  ligatures  separately  tied,  and  the  sac  resected. 
The  margins  of  the  abdominal  opening  were  curetted  and  united  by 
three  silk  sutures.  The  cutaneous  lips  of  the  wound  were  brought  into 
intimate  contact  by  interrupted  sutures.  The  wound  was  covered 
with  collodion,  over  which  was  applied  a  cotton-wool  dressing  and 
bandage. 

The  patient  was  fed  on  milk  and  a  little  meat.  In  the  evening  the 
temperature  was  38'8°  C. 

The  sequelae  were  very  trifling,  the  temperature  never  exceeding 
39-2°  C. 

On  the  22nd  October  the  dressing  was  removed.  The  upper  two 
thirds  of  the  wound  had  healed  throughout  ;  in  the  lower  third  the  lips 
were  swollen,  retracted,  and  discharging.  They  were  cleansed  with 
carbolic  solution  and  a  new  cotton-wool  dressing  applied. 

On  the  26th  the  cutaneous  sutures  were  cut  and  removed.  On  the 
30th  dressing  was  discontinued.  The  wound  had  healed,  and  the  hernia 
was  cured. 

82.  A  five-year-old  setter  bitch,  left  in  hospital  8th  February,  1895, 
Had  been  ill  for  five  days,  showing  symptoms  of  intestinal  obstruc- 
tion, loss  of  appetite,  dulness,  groaning,  vomiting,  constipation,  and 


HERNL'E.  373 

sensitiveness  over  the  abdomen  ;  but  none  of  these  symptoms  in  a  ver}^ 
severe  form.  Examination  of  the  abdomen  and  rectum  gave  no 
information. 

Treatment. — Administration  of  castor  oil,  hypodermic  injection  of 
two  milHgrammes  of  eserine,  and  warm  water  enemata.    Dead  next  day. 

Autopsy. — A  Httle  reddish  serosity  in  the  peritoneum  ;  intense  con- 
gestion of  a  portion  of  the  intestines.  On  isolating  the  convolutions  it 
was  seen  that  a  part  of  the  intestine  had  passed  into  the  thorax. 
The  upper  margin  of  the  diaphragm  opposite  the  right  pillar  showed  a 
narrow  tear,  through  which  the  hernia  had  occurred.  On  opening  the 
chest  about  fourteen  inches  of  the  last  portion  of  the  jejunum  were 
found.  The  gut  was  blackish  in  colour,  its  coats  greatly  thickened  and 
oedematous.  The  opening  through  which  the  intestine  had  passed  was 
oval  in  form,  its  greatest  length  being  vertical.  The  fibrous  condition 
of  the  margins  showed  it  to  be  of  old  standing. 

On  auscultating  the  chest  we  might  undoubtedly  have  noted  bor- 
borygmus,  but  the  diagnosis  would,  nevertheless,  have  remained  doubt- 
ful, in  view  of  the  rarity  of  diaphragmatic  hernia  in  the  dog. 

83.  Six-year-old  bay  mare,  seen  at  midnight  on  the  2nd  March, 
1894. 

History. — Shortly  before  the  first  symptoms  appeared  the  animal 
had  had  "  a  severe  twist  round  with  the  van."  The  attack  commenced 
at  3.30  p.m.,  and  the  mare  reached  home  at  6  p.m. 

State  on  Examination. — Acute  persistent  pain,  great  excitement,  free 
perspiration.  Pulse  hard,  small  and  frequent.  Temperature  105°  F. 
Chloral  and  enemas  were  given  freely.  The  animal  continued  violent, 
rapidly  became  weaker,  and  died  at  2.15  p.m.  on  March  3rd. 

Autopsy  revealed  a  rupture  one  and  a  half  inches  long  on  the  inner 
border  of  the  muscular  portion  of  the  right  side  of  diaphragm,  through 
which  several  loops  of  the  small  intestine  (ten  or  twelve  feet  from  the 
ileo-caecal  valve)  had  passed.  The  pleura  covering  the  anterior  surface 
of  the  diaphragm  was  separated,  thickened,  and  enclosed  the  intestine 
like  a  bag.  The  intestine  could  not  be  pulled  back  into  the  abdomen, 
for  it  was  strangulated.  The  loop  was  very  full  of  dark-coloured  blood. 
The  bag-like  swelling  in  the  chest  was  as  large  as  two  cocoa-nuts,  was 
tense,  and  attached  by  exudate  to  the  right  side  of  the  chest.  The 
whole  of  the  small  intestine  from  the  hernia  to  the  stomach  was  greatly 
dilated,  and  filled  with  sanious  watery  fluid. 

Mr.  G.  C.  Lowe's  case,  Joum.  Conip.  Path,  and  Therap,,  1894,  p.  75. 

84.  A  ten-year-old  mare  showed  on  post-mortem  examination  a  rent 
one  inch  in  diameter  about  the  middle  of  the  muscular  portion  of  the 
diaphragm,  through  which  a  considerable  portion  of  the  gastro-colic 
omentum  had  passed  and  become  attached  to  the  fifth  rib  of  the  right 
side.  The  accident  was  of  considerable  standing,  as  the  displaced 
fragments  were  firmly  ossified.  During  the  four  years  previous  to 
death  the  animal  had  never  shown  a  day's  illness.  The  case  proves 
that  rupture  of  the  diaphragm  is  by  no  means  necessarily  fatal. 

Mr.  H.  D.  Young's  case,  Veterinarian,  1894,  p.  259. 


374  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

85.  In  the  Veterinarian  for  1845  is  described  a  case  of  strangulated 
phrenic  hernia  in  a  mare,  whose  history  for  eighteen  months  prior  to 
death  did  not  disclose  any  accident,  and  yet  autopsy  revealed  a 
fractured  rib,  to  which  the  displaced  intestine  was  firmly  attached. 
The  opening  in  the  diaphragm  was  only  "  large  enough  to  admit  the 
thumb." 

Mr.  Gabriel's  case. 

CANCER    OF    THE    STOMACH. 

86.  An  eleven-year-old  mare,  brought  for  examination  on  the  5th 
June,  1894. 

The  only  information  tendered  was  as  follows :  Had  been  in  the 
owner's  possession  for  several  years,  and  always  worked  satisfactorily 
until  the  3rd  June.  No  digestive  trouble,  nor  sign  of  any  disease 
whatever  had  been  noted  previous  to  that  date.  Suddenly  the  animal 
appeared  depressed,  uneasy,  and  without  appetite.  It  had  coughed  a 
little. 

State  on  Examination. — The  patient  was  prostrate ;  the  mucous 
membrane  injected;  the  respiration  rapid  (18  to  20  per  minute),  the 
pulse  small  (70),  the  rectal  temperature  39'6°  C. 

Percussion  of  the  chest  was  painful,  and  revealed  slight  dulness  of 
the  lower  half  of  either  side.  On  auscultation  of  this  region  the 
vesicular  murmur  was  diminished.  The  heart-sounds  were  feeble  and 
irregular.  The  abdomen  was  slightly  painful  on  palpation.  The  mare 
was  regarded  as  suffering  from  pneumo-enteritis. 

Treatment. — Bleeding,  mustard  plasters,  alcohol,  digitalis. 

During  the  night  the  symptoms  became  aggravated.  The  pulse 
rose  to  75°  C,  the  respirations  to  40.     The  patient  refused  all  food. 

On  the  morning  of  the  6th  June  the  condition  was  still  graver.  The 
mare  was  extremely  depressed,  and  occasionally  scraped  the  ground 
with  her  foot.  The  conjunctiva  was  deep  red ;  the  respiration  short, 
tumultuous,  and  discordant.  Nothing  fresh  could  be  discovered  on 
auscultation  or  percussion  of  the  chest ;  the  walls  of  the  chest  were 
still  very  sensitive ;  the  heart-sounds  feeble  ;  the  pulse  was  scarcely 
perceptible.  There  was  slight  muscular  trembling,  especially  opposite 
the  point  of  the  elbow.  Temperature  39*2°  C.  Half  an  hour  later  the 
condition  suddenly  became  alarming.  The  patient  looked  extremely 
anxious,  lay  down  and  rose  again  several  times  with  great  care,  then 
suddenly  groaned,  leaned  against  the  wall,  rolled  from  side  to  side,  and 
fell  heavily.  The  necks  and  limbs  became  stiff,  the  face  drawn,  the 
respirations  more  and  more  rapid,  and  death  occurred  after  a  short 
struggle. 

Autopsy. — Several  quarts  of  reddish  liquid  in  the  abdominal  cavity. 
Lesions  of  peritonitis  ;  different  portions  of  the  serous  membrane,  and 
especially  of  the  epiploon,  were  congested  and  hjemorrhagic.  The 
pleural  cavity  contained  a  certain  quantity  of  liquid  resembling  that  in 
the  peritoneal,  and  showed  similar  changes  to  the  latter.  The  viscera 
were  congested  and  dotted  over  with  ecchymoses.  These  changes 
were  secondary,  and  had  been  produced  by  a  septic  process  originating 
in  the  stomach. 


CANCER    OF    THE    STOMACH.  375 

The  stomach  itself,  which  was  large  and  very  heavy,  was  adherent 
to  the  diaphragm  over  an  area  of  g  inches  by  7  inches.  The  adhesions 
were  particularly  marked  near  the  small  curvature,  towards  the 
termination  of  the  oesophagus,  where  the  serous  coverings  of  the 
stomach  and  diaphragm  become  continuous.  These  adhesions  were 
supplemented  by  an  enormous  number  of  short,  fibrous  bands,  some 
old,  others  of  recent  formation.  While  the  posterior  portions  of  the 
wall  of  the  stomach  were  normal,  or  nearly  so,  the  anterior  were 
thickened,  hard,  and  bosselated  around  the  adherent  area.  On  being 
removed  and  incised  along  its  greater  curvature,  the  stomach  showed 
an  enormous  ulcerated  swelling  developed  on  the  anterior  wall  of  the 
left  cid-dc-sac. 

This  new  growth  was  of  irregular,  triangular  shape,  the  base  being 
upwards  ;  it  measured  loi  inches  in  length  by  gi  inches  in  width. 
Limited  above  by  a  horizontal  line  which  followed  the  small  curvature, 
and  of  which  the  cardia  occupied  the  central  part,  it  extended  along 
the  mucous  membrane  of  the  oesophagus,  forming  a  small  reddish  patch, 
clearly  visible  against  the  whitish  ground  of  the  adjacent  normal 
mucous  membrane.  This  patch  was  but  slightly  elevated  above  the 
surrounding  parts,  and  did  not  sensibly  diminish  the  lumen  of  the  canal. 

The  lesion  stopped  exactly  at  the  line  of  separation  between  the 
cuticular  and  villous  portions  of  the  gastric  mucous  membrane,  leaving 
the  latter  intact.  On  the  left  side  the  principal  ulcer  was  very 
irregular  in  shape  ;  its  margins  were  indurated  and  excavated  ;  at  points 
the  mucous  membrane  was  thickened,  loosened,  scalloped,  or  exhibited 
apertures  due  to  circular  losses  of  substance — some  of  which  were 
as  large  as  a  sixpence ;  all  produced  by  extension  of  the  process  under  the 
mucous  membrane,  and  by  ulceration  of  the  latter. 

Around  the  margins  of  the  injury  the  walls  of  the  stomach  were 
everywhere  thickened  and  indurated  for  a  width  of  2A  inches  to  4 
inches.  At  several  points  the  submucous  connective  tissue  was  also 
oedematous. 

The  tumour  was  not  of  the  same  appearance  and  character  through- 
out. A  portion  of  the  upper  part — about  six  by  four  inches  immediately 
below  the  cardia — was  very  prominent,  soft  in  consistence,  and  reddish 
or  violet  in  colour,  according  to  the  point  examined.  This  first  part 
was  limited  below  by  a  deep  semicircular  groove.  Over  the  rest  of  its 
surface  the  ulcer  was  covered  with  reddish,  rounded,  irregular  vegeta- 
tions, varying  in  size  between  a  pea  and  a  hazel  nut,  separated  by 
sinuous  depressions  filled  with  an  ichorous  stinking  material. 

On  cutting  through  the  walls  of  the  stomach  from  the  cardia  to  the 
lower  portion  of  the  ulcer,  i.  e.  through  the  entire  thickness  of  the 
tumour,  the  serous  and  muscular  layers  were  seen  to  be  greatly  thick- 
ened and  indurated  by  infiltration  with  the  new  growth  ;  the  muscular 
tissue,  however,  was  only  ulcerated  opposite  a  few  of  the  above-men- 
tioned grooves.  The  projecting  mass  formed  by  the  upper  part  of  the 
tumour  contained  irregular  communicating  spaces  with  friable  walls — 
spaces  filled  with  sloughing  debris  and  ichorous  liquid. 

This  tumour  had  certainly  existed  for  several  months,  but  its 
insidious  development  (it  had  produced  no  apparent  disturbance  until 


376  CLINICAL    VETERINARY'  MEDICINE    AND    SURGERY. 

two  days  before  death),  and  especially  the  absence  of  digestive  disturb- 
ance, were  explained  by  the  seat  of  the  lesion  :  the  cardia  remained 
patent,  and  the  left  portion  of  the  stomach  sufficiently  wide  to  permit 
food  to  pass,  while  the  mucous  membrane  of  the  right  cul-de-sac  was 
normal. 

The  clitoris  showed  a  reddish,  mammilated  tumour,  the  size  of  a 
nut,  of  the  same  nature  as  that  in  the  stomach. 

The  growth  was  a  pavement  epithelioma.  Microscopically  examined 
it  appeared  formed  of  a  fibrous  stroma  and  masses  of  epithelial  cells 
arranged  in  anastomosing  bands  and  large  lobules,  the  centres  of  which 
were  occupied  by  spherical  groups  of  cells  undergoing  cornification 
(epidermal  nests). 

ABSCESS    OF    THE     LIVER    IN    THE    HORSE. 

87.  An  eleven-year-old  grey  Persian  mare,  first  admitted  to  hospital 
15th  May,  i8g8.  The  animal  was  very  dull,  but  showed  no  other 
symptoms;  w^as  treated  for  simple  fever,  and  discharged  to  duty  21st 
May. 

Readmitted  7th  September.  Since  the  previous  treatment  had  been 
dull  and  disinclined  for  food. 

State  on  Examination. — Appetite  entirely  in  abeyance  ;  signs  of  li^'er 
disorder,  membranes  yellow,  fever,  intense  dulness  ;  pulse  50,  respira- 
tions 20. 

Treatment. — Tonics  and  nourishing  food. 

By  the  31st  May  the  animal  had  improved,  but  the  membranes 
were  paler  and  more  anaemic.  Considerable  bodily  wasting  had 
occurred,  the  urine  was  brownish  and  very  offensive,  but  free  from  bile 
or  albumen ;  fseces  normal.  The  most  careful  examination  of  all 
accessible  organs  revealed  nothing. 

On  the  3rd  October  the  faeces  were  dark  in  colour,  very  offensive, 
and  contained  much  mucus.     Urine  free  of  albumen  or  bile. 

On  the  gth  the  animal  fell  and  remained  down  in  its  box  for 
two  hours,  rising  again  of  its  own  accord  ;  this  was  the  only  occasion 
on  which  it  ventured  to  lie  down. 

On  the  15th  muscular  wasting  was  intense,  the  pulse  quicker, 
respirations  increased  ;  the  case  was  evidently  sinking. 

On  the  17th  and  i8th  the  animal  walked  aimlessly  round  its  box  ; 
pulse  imperceptible ;  early  on  the  morning  of  the  19th  it  died. 

Autopsy. — On  opening  the  abdomen  about  two  quarts  of  inspissated 
pus  mixed  with  serum  escaped ;  peritoneum  inflamed  and  covered  with 
lymph  ;  the  transverse  colon  and  extremity  of  caecum  were  highly 
inflamed,  preparatory  to  adhesion,  for  the  right  portion  of  the  double 
colon  was  already  firmly  attached  to  the  abdominal  wall.  The  liver 
was  mottled,  and  its  entire  anterior  surface  adherent  to  the  diaphragm  ; 
it  weighed  20  lbs.  The  hepatic  lobules  were  swollen  and  engorged  with 
blood.  On  section  the  organ  appeared  gritty  ;  the  right  lobe  contained 
a  large  abscess,  the  contents  of  which  had  burst  into  the  peritoneal 
cavity  ;  the  walls  of  this  abscess  varied  in  thickness,  measuring  at 
places  three  or  four  inches,  and  at  others  being  as   thin    as    paper; 


INTESTINAL    OBSTRUCTION.  377 

rupture  had  occurred  at  the  thin  part  ;  the  right  lobe  alone  contained 
seven  abscesses  in  various  stages,  and  the  whole  liver  at  least  twenty 
yellow  cheesy  deposits — the  nuclei  of  future  abscesses  (?).  The  walls 
of  the  stomach  were  two  to  three  inches  thick  ;  the  cuticular  portion 
was  thickened,  of  a  dirty  yellow  colour,  and  resembled  a  honeycomb  ; 
these  changes  were  the  result  of  inflammatory  action,  and  due  to  an 
attempt  to  glue  the  main  abscess  to  the  stomach,  so  as  to  afford  an 
outlet  for  it.     (This  case  occurred  in  India.) 

Prof.  F.  Smith,  Journ.  Comp.  Path,  and  Therap.,  1891,  p.  355. 

INTESTINAL    OBSTRUCTION. 

88.  A  fifteen-month-old  spaniel,  left  in  hospital  5th  February,  1895. 

This  animal  rarely  left  the  shop  where  it  lived.  On  the  2nd 
February  it  refused  food.  Meat  and  other  food,  of  which  it  was  gene- 
rally fond,  were  offered,  but  in  vain.  It  would  only  take  cold  water. 
These  symptoms  continued  on  the  3rd  and  4th  of  February.  The 
animal  was  brought  to  the  school  next  day. 

State  on  Exauiination. — The  animal  was  feverish  and  appeared  in 
great  pain  ;  it  lay  down  on  its  chest  with  the  head  extended  on  the  fore 
paws,  and  paid  no  attention  to  what  passed  around  it.  The  mouth  was 
hot,  the  eye  retracted  into  the  orbit,  the  conjunctiva  injected.  Respira- 
tion and  circulation  were  very  rapid,  the  heart  beat  tumultuously,  and 
at  times  expiration  was  accompanied  by  groaning.  The  animal  would 
not  touch  food,  but  greedily  drank  cold  water.     Urine  normal. 

The  abdomen  was  not  painful.  Nevertheless,  as  faeces  had  not  been 
passed  for  thirty-six  hours,  intestinal  obstruction  was  suspected. 

Treatment. — Administration  of  ij  ounces  of  oil  and  warm  water 
enemata. 

The  animal's  strength  was  supported  by  spoon  feeding  with  milk 
containing  ij  drachms  of  bicarbonate  of  soda. 

On  the  morning  of  the  6th  February  the  general  condition  appeared 
better  than  on  the  previous  evening.  The  dog  seemed  to  have 
recovered  its  appetite,  and  took  a  few  mouthfuls  of  solid  food.  Liquid 
excrement  was  found  in  the  kennel.  Manipulation  of  the  abdomen 
produced  slight  pain,  but  no  foreign  body  was  discovered.  The  same 
treatment  was  continued. 

On  the  5th  February  depression  and  feebleness  were  more  marked 
than  on  the  previous  evening.  The  animal  could  scarcely  stand. 
Died  during  the  night. 

Autopsy. — The  anterior  portion  of  the  intestine  was  dilated,  very 
greatly  congested,  and  about  twelve  inches  from  the  stomach  con- 
tained a  large  rounded  object.  On  incision  an  india-rubber  ball  was 
found  obstructing  the  lumen  of  the  tube. 

Remark. — A  number  of  cases  of  intestinal  obstruction  in  the  dog 
accompanied  by  symptoms  resembling  rabies  have  been  described. 
In  that  just  mentioned,  and  in  a  number  of  others,  nothing  suggestive 
of  rabies  was  noted.  In  reality  these  rabidiform  symptoms  are  seldom 
seen  except  in  dogs  of  naturally  bad  temper,  or  in  cases  where  the 
foreign  body  has  torn  the  intestinal  mucous  membrane. 


378  CLINICAL  vetp:rinary  medicine  and  surgery. 


PERFORATION    OF    THE    INTESTINE. 

8g.  An  eighteen-month-old  sheep-dog,  left  in  hospital  loth  May, 
1898. 

Though  usually  very  bright  and  playful,  this  dog  had  two  days 
before  suddenly  become  dull  and  refused  food.  It  moved  unwillingly, 
and  only  when  forced.  There  were  no  symptoms  resembling  rabies. 
The  condition  was  referred  to  the  animal  having  swallowed  some  fish- 
bones (pike). 

On  entering  its  kennel  the  animal  lay  down  on  the  right  side  and 
moaned.  As  it  refused  all  food,  milk  was  given  by  a  spoon.  Died 
next  day. 

Autopsy. — Lesions  of  diffuse  acute  peritonitis.  The  entire  intestinal 
mass  was  greatly  congested. 

Towards  the  centre  of  the  small  intestine  was  a  perforation  due  to 
a  fragment  of  bone  (from  the  upper  half  of  a  sheep's  tibia).  In  front  of 
this  bone  the  intestine  was  distended  by  grass,  which  the  animal  had 
doubtless  swallowed  when  it  felt  the  first  pains  due  to  obstruction. 

90.  A  three-year-old  setter  dog,  left  in  hospital  5th  June,  i8g8. 

The  animal  had  appeared  unwell  three  days  before,  and  remained 
continually  recumbent.  If  forced  to  move  it  walked  slowly,  showed 
pain,  and  howled.  Appetite  was  entirely  lost.  At  times  there  was 
nausea  and  vomiting  of  yellowish  bilious  material. 

When  brought  here  the  animal  was  in  a  grave  state  ;  it  no  longer 
recognised  its  master,  and  took  no  notice  when  called.  It  walked  with 
short  steps,  the  back  bowed,  and  the  limbs  thrust  apart.  The  abdomen 
was  tense  and  painful  on  pressure  ;  the  pulse  rapid  and  feeble  ;  the 
respiration  frequent,  expiration  being  at  times  moaning ;  temperature 
40°  C. 

Placed  in  a  kennel  the  animal  lay  on  its  side  with  the  head  and  legs 
extended.  It  refused  to  drink  milk,  and  was  therefore  fed  by  hand. 
The  condition  rapidly  became  aggravated,  and  death  occurred  during 
the  night. 

Autopsy. — Lesions  of  purulent  peritonitis. 

Towards  its  centre  the  duodenum  was  greatly  swollen  ;  the  surface 
of  the  right  half  was  inflamed  and  granulating.  In  the  thickened  wall 
of  this  portion,  lying  almost  parallel  to  the  general  direction  of  the 
intestine,  was  a  needle  two  and  a  half  inches  in  length,  the  eye  of 
which  contained  a  worsted  thread,  twenty  inches  long,  enveloped  in 
the  thickness  of  the  intestinal  tunics. 

In  front  of  the  point  where  the  needle  had  become  inserted  the 
duodenum  was  dilated ;  behind  it  was  contracted  and  empty. 

Remark. — The  symptoms  which  follow  small  perforations  of  the 
wall  of  the  stomach  or  intestine  by  needles  differ  widely,  according  to 
whether  the  needle  does,  or  does  not,  carry  a  thread.  The  thread 
when  present  becomes  the  carrier  of  septic  materials,  which  almost 
always  produce  fatal  peritonitis.  On  the  other  hand,  needles  alone 
often  pass  through  the  intestine  without  causing  any  appreciable 
symptoms.     When  they  become  implanted  in  the  liver  they  are  usually 


SUBCAPSULAR    H/EMORRHAGE    IN    THE    LIVER    OF    THE    HORSE.  379 

encysted,  and  may  remain  permanently  in  position  without  producing 
any  notable  effect. 

SUBCAPSULAR    HEMORRHAGE    IN    THE    LIVER    OF    THE    HORSE; 
PARTIAL    RECOVERY;    RELAPSE    AND    DEATH. 

gi.  A  lifteen-year-old  dun  gelding,  seen  about  8.  p.m.,  i8th  June, 
1896. 

History. — Said  to  have  been  suffering  from  colic.  At  5  p.m.  a  small 
quantity  of  faeces  had  been  passed,  and  the  animal  had  afterwards 
staled. 

State  on  Examination. — The  animal  was  standing  quietly,  its  head 
thrust  a  little  forward,  its  face  drawn,  pupils  dilated,  legs  straddled 
apart,  muscles  quivering,  and  its  whole  body  bathed  in  cold  perspira- 
tion. The  mouth  was  cold,  the  conjunctiva  pale,  the  tongue  and  lips 
were  blanched  and  flaccid.  The  pulse  was  94,  very  small  and  weak ; 
temperature  loof^;  the  respirations  were  about  31,  shallow  but  not 
noisy,  and  the  nostrils  were  dilated.  Within  a  few  minutes  the  animal 
began  to  walk  round  its  box,  cringing  from  time  to  time  towards  the 
right  side,  turning  its  head  in  the  direction  of  the  right  flank,  but 
seldom  lying  down.  This  wandering  round  was  occasionally  inter- 
rupted, the  animal  standing  in  one  place,  pawing  violently,  stretching 
out  its  head,  and  curling  its  upper  lip.  Vision  appeared  defective,  for 
the  head  was  several  times  struck  against  the  side  of  the  box,  while 
the  pupil  scarcely  reacted  on  the  approach  of  a  light.  Raising  the 
head  caused  staggering. 

As  the  animal  had  been  resting  for  ten  days  and  had  not  been  out 
of  its  box,  and  as  the  attack  was  of  sudden  onset,  the  history  threw 
little  light  on  it.  The  suddenness  of  the  attack,  the  extreme  depression, 
dilatation  of  the  pupil,  paleness  of  the  membranes,  and  general  blood- 
lessness  seemed  to  point  to  internal  haemorrhage,  while  the  animal's 
age,  considered  in  conjunction  with  the  known  frequency  of  rupture  of 
the  liver  in  the  horse,  seemed  to  warrant  the  diagnosis  of  ruptured 
liver.  As  very  little  more  could  be  done  than  relieve  pain,  a  hypo- 
dermic injection  of  seven  grains  hydrochlorate  of  morphine  was  given, 
it  being  considered  too  dangerous  to  attempt  giving  a  draught. 

This  afforded  some  relief,  and  for  about  forty  minutes  the  animal 
kept  wandering  round  its  box  or  occasionally  standing  still  and  pawing. 
Just  as  death  seemed  imminent,  it  went  down  rather  heavily,  struggled 
a  good  deal,  stretched  out  its  legs  stiffly,  groaned  deeply  several  times, 
and  apparently  died.  In  about  a  minute,  however,  it  gathered  itself 
together,  rose  and  stood  swaying  about  stupidly,  but  apparently  in  less 
pain  than  before.  At  this  time  the  pulse  was  about  130  to  140,  small 
and  thready  ;  the  respirations  about  30,  but  shallow  and  quiet.  The 
temperature  was  not  taken. 

Directions  were  given  that  the  animal  should  be  kept  perfectly  quiet, 
placed  on  low  diet,  and  general  precautions  be  adopted  against  its 
catching  cold  or  injuring  itself.  In  point  of  fact  death  was  expected  to 
occur  within  a  few  hours. 

Next  day,  however,  the  patient  was  still  alive  and  distinctly  better. 


380  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

Pulse  82,  respirations  75,  temperature  100°,  pupil  still  rather  dilated, 
surface  temperature  better  distributed  ;  the  bowels  and  kidneys  had 
acted,  the  former  slightly,  and  the  animal  had  eaten  a  little  mash. 
Trifling  jaundice,  which  had  been  overlooked  the  evening  before,  was 
noted. 

Slow  but  steady  progress  was  maintained  until  11.30  a.m.  on  June 
29th  {i.e.  eleven  days),  on  which  date  the  pulse,  temperature,  and 
respirations  were  nearly  normal.     At  3  p.m.  the  horse  died. 

Post-mortem  examination  revealed  profuse  intra-abdominal  haemor- 
rhage, and  pronounced  yellow  staining  of  all  the  internal  organs.  The 
foam  in  the  bronchi  was  tinged  yellow,  the  bowels  were  similarly 
tinted  ;  the  kidneys,  though  otherwise  normal,  were  of  a  like  shade, 
and  everywhere  the  abdominal  fat  was  deeply  coloured.  The  principal 
interest  of  the  case  centred  in  the  liver,  which  was  of  enormous  size, 
weighing  over  58  lbs.  Owing  to  the  large  subcapsular  clots  being  in 
great  part  lost  during  removal  of  the  liver  from  the  abdominal  cavity, 
this  is  probably  a  low  estimate.  One  of  these  clots  removed  from  the 
left  lobe  weighed  13  lbs.  of  itself,  and  several  others  existed.  The  liver 
showed  excessive  fatty  degeneration,  was  yellowish  to  dull  brown  in 
colour,  pultaceous,  broke  down  under  the  slightest  pressure,  and  per- 
mitted of  the  capsule  being  readily  stripped  at  all  points.  Normal 
liver  tissue  seemed  absolutely  wanting.  The  capsule  of  the  left  lobe 
was  separated  (by  haemorrhage)  over  an  area  about  nine  inches  square. 
The  contained  clot  was  firmer  than  the  others,  and  appeared  to  be 
undergoing  absorption.  The  right  lobe  showed  somewhat  less  exten- 
sive change  than  the  left,  but  subcapsular  breathing  had  occurred  and 
the  capsule  had  ruptured,  allowing  of  free  haemorrhage  into  the  abdo- 
minal cavity.  The  space  between  capsule  and  liver  substance  contained 
a  clot  weighing  about  6i  lbs.  Sections  through  the  liver  showed 
internal  haemorrhages  of  all  ages  throughout  the  organ ;  at  some  spots 
a  few  dark  brown  patches  were  all  that  remained,  at  others  the  blood 
was  still  nearly  fluid.  It  was  scarcely  possible  to  find  a  cubic  inch 
without  a  haemorrhage. 

Viewed  in  light  of  the  facts  shown  by  post-mortem-  examination,  it 
seems  probable  that  the  first  attack,  on  the  i8th  June,  was  due  to  sub- 
capsular haemorrhage  in  the  left  lobe,  where  the  clot  seemed  to  be 
oldest;  that  under  the  combined  influences  of  lowered  blood-pressure 
in  the  arteries,  and  increased  local  pressure  at  the  seat  of  bleeding,  the 
loss  gradually  ceased  with  the  effects  noted,  but  that  on  the  second 
occasion  haemorrhage  was  followed  by  rupture  of  the  capsule,  free 
bleeding  into  the  abdominal  cavity,  and  rapid  death  from  syncope. 

Mr.  Jno.  A.  W.  Dollar's  case,  I'eterinarian,  1896,  p.  668. 

CHYLOUS    ASCITES    IN    THE    CAT— MENINGITIS    AS    AN 
ACCOMPANIMENT, 

92.  A  large  black  male  cat  about  eight  years  old,  first  seen  on  the 
I2th  April,  1895. 

History. — Five  weeks  previously  the  animal  had  been  caught  in  a 
shower  of  rain,  and  a  week  later  its  abdomen  appeared  swollen  ;  it  was 


CHYLOUS    ASCITES    IN    THE    CAT. 


381 


rather  dull,  and  lay  curled  up  in  its  basket,  but  took  food  fairly  well. 
Swelling  continued  to  increase,  but  the  abdomen  was  not  tender  or 
painful  on  palpation.  About  the  end  of  March  sw^elling  had  become 
considerable,  and  in  descending  a  long  flight  of  stone  steps  the  animal 
overbalanced,  and  rolled  from  top  to  bottom.  To  the  previous  difficulty 
in  movement  (probably  due  to  enlarged  abdomen)  a  new  symptom  was 
now  added :  the  animal  seemed  "  weak  in  its  hind  quarters,"  and 
when  turning  staggered  considerably,  but  soon  recovered  itself ;  it  could 
walk  quite  steadily  so  long  as  it  continued  in  a  straight  direction. 

State  on  Examination. — Pulse  about  200,  small,  rather  wiry  and 
difficult  to  detect.  Respirations  26.  Temperature  103!°  F-  Nose 
and  mouth  hot,  dry,  and  offensive,  tongue  coated  and  whitish  brown  in 
colour.  Appetite  bad,  no  great  desire  for  either  food  or  milk.  General 
condition  poor,  abdomen  enormously  distended  and  pendulous ;  the 
animal  was  "  pot-bellied,"  and  walked  with  the  hind  legs  semi-flexed, 
the  abdomen  almost  in  contact  with  the  ground   (apparently  in  conse- 


FiG.  37. — Chylous  ascites.     Showing  the  enormous  distension  of  the  abdomen, 
and  the  falling  away  about  the  hind  limbs,  spinal  column,  and  neck. 


quence  of  the  feeling  of  insecurity  due  to  inability  to  control  movements 
of  the  hind  limbs).  Supporting  the  abdomen  seemed  grateful  to  the 
animal.  The  coat  was  dull  and  in  process  of  shedding,  leaving  bare 
patches,  though  the  skin  seemed  normal.  The  vertebrae  were  unusually 
prominent,  the  flank  fallen  in,  the  hind  quarters  and  thighs  wasted. 
The  animal  weighed  10^  lbs. 

The  posterior  portion  of  the  neck,  the  back  from  the  dorsal  to  the 
lumbar  region,  and  the  tail  seemed  insensitive.  When  pricked  the 
animal  failed  to  respond  except  locally — there  was  slight  local  twitching, 
— but  if  the  needle  were  more  vigorously  employed  it  half  turned  its 
head,  and  seemed  for  a  moment  to  reflect.  A  second  or  third  stimulus 
might  cause  it  to  turn  the  head  completely  round,  but  it  never  seemed 
sensible  of  the  exact  site  of  injury,  or  of  any  real  pain.  Sometimes  it 
licked  a  point  adjoining  that  touched,  sometimes  one  three  or  four 
inches  away. 

There  was  incomplete  paraplegia  of  both  hind  limbs,  difficult  to 
exactly  marginate.     The  gait  was  very  unsteady,  the  animal,  especially 


382  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

when  turning  a  corner,  suddenly  swerving  to  the  right  or  left,  and 
nearly  or  completely  falling  over.  There  was  marked  disinclination  to 
remain  on  any  elevated  spot.  If  placed  on  a  table  the  animal  ap- 
proached the  edge,  and  after  deliberating  for  a  moment  (all  its  move- 
ments were  very  deliberate)  slowly  glided  off  towards  the  ground.  It 
was,  however,  unable  to  resist  the  shock,  and  fell  over  almost  helpless. 
When  placed  in  a  basket  it  appeared  comfortable,  seldom  changing  its 
position,  and  did  not  move  even  when  the  basket  was  slowly  inclined 
until  it  lay  with  the  head  undermost.  It  could,  however,  still  walk 
fairly  well  in  a  straight  line,  could  ascend  and  descend  stairs  without 
falling,  and  could  spring  over  low  obstacles.  The  bowels  and  kidneys 
acted  regularly,  the  bladder  was  under  control,  though  the  innervation 
of  the  rectum  seemed  somewhat  defective,  causing  defecation  to  be 
difficult. 

The  pupils  responded  readily  to  light,  and  vision  seemed  perfect, 


Fig.  38. — Chylous  fluid,  freshly  withdrawn. 

though  the  animal  only  winked  languidly  when  threatened.  There  was 
no  change  in  the  cornea. 

The  knee-jerks,  as  tested  by  Professor  Victor  Horsley,  were  fnot 
exaggerated. 

Diagnosis. — Ascites,  consequent  on  chronic  peritonitis,  probably 
complicated  with  cerebellar  tumour.  The  cat  was  killed  with  chloro- 
form. 

Post-mortem  Examination. — The  skull  was  exceptionally  well  deve- 
loped, the  occipital  and  parietal  crests  being  especially  prominent  and 
the  diploe  dense. 

On  opening  the  cranial  cavity  about  half  to  three  quarters  of  an 
ounce  of  a  glairy  reddish  serous  liquid  escaped.  It  was  accumulated  in 
greatest  amount  about  the  falx  cerebri,  the  posterior  aspect  and  base 
of  the  brain. 

The  meninges  were  infiltrated  with  it,  and  the  liquid  continued  to 
ooze  away  for  some  minutes.  The  meningeal  vessels  were  congested, 
and  there  was  well-marked  meningitis.  The  brain  seemed  to  have 
suffered  little  change. 


CHYLOUS    ASCITES    IN    THE    CAT MENINGITIS    AS    AN    ACCOMPANIMENT.      383 

The  abdomen  contained  about  30  ounces  of  a  thin  white  fluid 
exactly  resembhng  milk,  and  the  internal  organs  showed  the  following 
appearances. 

The  serous  coat  of  the  bowel  was  covered  with  small  elongated 
whitish  spots  resembling  minute  worms,  many  of  which  were  not  larger 
than  grains  of  sand.  On  being  pricked,  the  larger  exuded  a  minute 
drop  of  the  same  milk}-  fluid  as  was  found  in  the  abdomen.  Along  the 
free  border  of  the  bowel,  furthest  from  the  mesentery,  and  most  marked 
in  the  duodenum  and  jejunum,  were  minute  red  commencing  granu- 
lations. The  gastro-splenic  omentum  was  bright  pink  in  colour,  and 
showed  numerous  areas  of  what  appeared  like  chyle  extravasation — 
whitish  spots  the  size  of  a  threepenny  piece,  from  which  fluid  escaped 
on  pricking.  In  and  on  the  serous  membrane,  and  especially  around 
the  mesenteric  vessels,  were  deposits  of  lymph. 

The  liver  showed  subperitoneal  lymph  effusion,  and  on  incision  the 
lobules  were  marginated  by  a  pearly-grey  infiltration. 

The  spleen  was  covered  with  greyish  points  of  lymph  effusion.    The 


Fig.  39. — Microscopic  appearance  of  fresh  mill^.     Ail  tliese  figures  are 
drawn  to  the  same  scale. 

kidneys  showed  well-marked  fatty  change,  which  on  microscopic  exa- 
mination seemed  to  be  fatty  degeneration.  The  bladder  was  full  of 
urine. 

The  peritoneum  had  everywhere  undergone  extensive  change.  Its 
shining  appearance  was  lost,  lymph  deposits  had  occurred  over  it, 
though  without  glueing  together  the  intestines,  and  in  some  places,  as 
shown  by  microscopic  examination,  the  lymph  was  undergoing  organi- 
sation. 

The  thoracic  duct  could  not  be  isolated. 

The  heart  appeared  enlarged,  and  had  suffered  fatty  change.  The 
muscular  tissue  was  lax  and  friable,  and  instead  of  a  deep  maroon  was 
brownish  in  tint.     It  left  a  greasy  stain  on  the  knife  after  cutting. 

The  lungs  were  dark  in  colour  and  congested.  The  inferior  border 
and  base  of  the  lungs  were  collapsed,  probably  in  consequence  of  the 
continued  pressure  of  the  abdominal  contents. 


384  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

The  ascitic  fluid,  when  freshly  withdrawn,  showed  the  appearances 
denoted  by  the  figure.  The  minute  granules  were  of  a  fatty  character ; 
they  dissolved  in  ether,  which  afterwards  left  a  greasy  stain  if  poured 
over  paper  and  allowed  to  evaporate.  A  few  leucocytes  were  also 
present.  Within  half  an  hour  of  withdrawal  this  milky  fluid  coagulated 
spontaneously,  forming  a  kind  of  soft  curd,  though  if  a  few  drops  of 
chloroform  were  previously  added  it  remained  fluid  and  without  per- 
ceptible smell  for  fourteen  days.  During  that  time  it  separated  into  two 
distinct  layers,  an  upper  thick  creamy,  and  an  under  serous  and  clearer 
layer.  For  the  purpose  of  comparison  a  drawing  of  a  specimen  of  milk 
is  appended. 

Mr.  Jno.  A.  W.  Dollar's  case,  Veterinarian,  1895,  p.  403. 

CHYLOUS    ASCITES    IN    THE    CAT. 

93.  A  male  cat  first  seen  on  the  28th  September,  1893. 

In  June  its  abdomen  was  abnormally  large,  and  afterwards  increased 
in  size.  The  animal  showed  occasional  dulness,  lay  down  on  its  side 
and  groaned  ;  at  other  times  it  seemed  quite  well.  Before  enlargement 
appeared  the  cat  used  sometimes  to  vomit  after  a  meal,  but  this 
symptom  afterwards  disappeared  and  the  appetite  became  ravenous. 
As  the  owner  refused  to  have  it  killed,  five  grains  of  potassium  iodide 
were  given  night  and  morning,  and  in  a  fortnight  the  abdomen  almost 
regained  its  former  dimensions,  but  began  to  refill  again  immediately 
treatment  was  stopped.     Killed  on  6th  November. 

Autopsy. — The  abdomen  contained  three  pints  three  ounces  of 
fluid  indistinguishable  from  cow's  milk.  The  lacteals  in  the  lower  part 
of  the  mesentery  were  distended  with  chyle,  but  no  rupture  or  abnor- 
mality could  be  detected  in  them.  The  thoracic  duct  between  the 
heart  and  receptaculum  chyli  contained  a  little  pale-pink  lymph ;  both 
it  and  the  receptaculum  chyli  appeared  intact.  The  blood-vessels  of 
the  omentum  and  mesentery  were  much  congested,  those  of  the 
peritoneum  less  so.  The  liver  was  fatty ;  the  other  organs  w^ere 
normal. 

Microscopically  the  fluid  resembled  ordinary  chyle.  It  contained 
no  epithelium  and  yielded  neither  sediment  nor  cream  when  passed 
through  the  centrifugal  machine. 

Mr.  H.  Gray's  case,  Jonrn.  Conip.  Path,  and  Therap.,  1893,  p.  375. 

CONSTIPATION. 

94.  A  four-year-old  setter,  suffering  from  constipation,  which  had 
resisted  purgatives. 

According  to  the  statement  of  the  person  in  charge  of  the  dog  the 
condition  had  existed  for  nearly  three  weeks.  The  animal  was  left  in 
the  School  for  treatment  on  the  21st  January,  1898. 

It  appeared  to  be  suffering  from  severe  abdominal  pain,  and  from 
time  to  time  made  expulsive  efforts.  On  manipulating  the  abdomen 
an  enormous,  very  hard  mass  was  felt,  formed  by  the  rectum  distended 
with  faeces. 

Attempts  were  made  to  evacuate  the  rectum  by  curettage,  but  the 


FOREIGN    BODY    IN    THE    RECTUM.  385 

amount  and  consistence  of  the  faeces  rendered  this  useless.  The 
animal  was  placed  on  milk  diet,  enemata  of  hot  water  were  slowly 
injected,  and  repeated  six  times  daily;  i  centigramme  (•15  grain)  of 
pilocarpine  was  subcutaneously  injected,  and  the  abdomen  was  mas- 
saged. 

This  treatment  was  continued  during  the  succeeding  four  days. 
Every  other  day  5  centigrammes  of  calomel  (|  grain)  were  given.  The 
animal  only  passed  very  small  quantities  of  faeces,  which  had  been 
softened  by  the  enemas. 

On  the  27th  each  enema  was  followed  b}'  the  passage  of  softened 
excrement.     The  calomel  was  stopped. 

On  the  following  day  the  animal  passed  a  large  quantity  of  semi- 
liquid  material  and  fragments  of  bone.  On  manipulation  of  the 
abdomen  the  hard  mass  formed  by  the  distended  rectum  could  no 
longer  be  detected. 

On  the  2Sth  several  evacuations. 

On  the  2gth  passage  of  almost  liquid  and  slightly  blood-stained  faeces. 
Every  minute  the  animal  made  expulsive  efforts.  It  was  fed  on  milk, 
containing  a  feeble  proportion  of  laudanum,  and  with  rice  and  milk. 

On  the  30th  similar  treatment.  The  excrement  no  longer  contained 
blood,  and  the  diarrhoea  had  diminished. 

On  the  following  days  the  stools  resumed  their  normal  appearance. 

95.  Six-year-old  water  spaniel,  left  in  hospital  14th  May,  1898. 
Had  for  some  months  shown  incontinence  of  urine,  and  was  then 

suffering  from  obstinate  constipation.  The  anus  was  swollen,  and 
formed  a  projection  as  large  as  a  man's  tist.  The  dog  continually 
made  efforts  to  defaecate.  The  rectum  was  obstructed  by  hardened 
excrement. 

Treatment. — Milk  diet ;  warm  water  enemas  every  two  hours. 

On  the  15th,  after  administration  of  several  enemas,  a  portion  of 
the  faecal  mass  could  be  broken  down  and  removed.  Two  centigrammes 
(i  grain)  of  calomel  were  administered  as  an  intestinal  antiseptic. 

During  the  three  following  days  the  enemas  and  calomel  were 
continued.  The  material  was  still  hard,  and  only  passed  in  small 
quantity.     Straining  was  still  frequent. 

On  the  20th  a  large  quantity  of  softened  excrement  was  passed. 

From  the  21st  to  25th  the  previous  symptoms  gradually 'diminished. 
The  animal  was  placed  on  ordinary  diet,  which  it  consumed. 

On  the  27th  the  stools  were  normal. 

Remark. — Among  methods  of  treating  constipation  in  the  dog,  that 
usually  recommended  comprises  administration  of  purgatives,  and 
mechanical  removal  of  faeces.  I  prefer  frequently  repeated  warm 
enemata,  milk  diet,  and  small  doses  of  calomel. 

FOREIGN    BODY    IN    THE    RECTUM. 

96.  A  one-year-old  King  Charles'  spaniel,  left  in  hospital  15th  April, 
1898. 

Though  usually  very  affectionate  this  dog  had,  during  the  preceding 
five  or  six  days,  become  bad  tempered  and  snappish.    It  even  attempted 

B  B 


386  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

to  bite  its  master  when  touched.  Appetite  was  lost,  and  dehcacies  of 
which  it  was  usually  very  fond  were  refused.  The  faeces  were  hard, 
streaked  with  blood,  and  only  passed  after  prolonged,  very  painful 
efforts ;  the  peritoneum  was  oedematous  ;  from  the  anus  escaped  a 
foetid  muco-purulent  liquid ;  the  anal  mucous  membrane  was  swollen. 
The  introduction  of  the  index  finger  into  the  rectum  caused  intense 
pain.  Three  fourths  of  an  inch  in  front  of  the  sphincter,  in  the  upper 
wall  of  the  rectum,  a  hard,  extremely  sensitive  swelling  could  be  de- 
tected, towards  the  centre  of  which  was  implanted  a  sharp  object— a 
needle  or  pin — projecting  an  eighth  of  an  inch  beyond  the  mucous 
membrane  and  pointing  obliquely  downwards  and  forwards. 

The  foreign  body  was  seized  and  removed  by  introducing  the  right 
index  finger  and  thumb  into  the  rectum.  It  proved  to  be  a  sharp 
needle  two  inches  in  length,  the  eye  of  which  contained  a  fragment  of 
thread. 

Subsequent  treatment  consisted  in  washing  out  the  rectum  with  a 
5  per  cent,  solution  of  creolin.  Recovery  was  complete  at  the  end  of  a 
few  days. 

RUPTURE  OF  THE  POSTERIOR  AORTA. 

97.  A  twelve-year-old  bay  mare,  brought  to  the  College  on  the 
afternoon  of  the  2nd  February,  1894. 

The  off  fore  fetlock  had  just  been  severely  injured  by  a  tramway 
car.  The  external  surface  of  the  joint  showed  a  contused  wound,  from 
which  a  little  bright  red  blood  flowed,  owing  to  injury  of  the  digital 
artery. 

The  animal  was  placed  in  the  trevis.  Despite  considerable 
struggling  the  wound  was  dressed,  the  lips  brought  together,  and  an 
antiseptic  compress  dressing  applied.  We  were  just  about  to  liberate 
the  animal  when  it  suddenly  collapsed,  and  showed  signs  of  dying  : 
excessive  pallor  of  the  mucous  membranes,  convulsive  movements, 
and  rotation  of  the  eyes.     Death  occurred,  in  a  few  moments. 

Autopsy. — On  opening  the  peritoneal  cavity  a  stream  of  blood 
escaped.  A  layer  of  semi-coagulated  blood  covered  the  intestinal 
contents.  After  removing  the  viscera  we  discovered  in  the  sublumbar 
region  an  enormous  sanguineous  swelling  formed  by  a  subperitoneal 
haemorrhage,  which  had  dissected  and  thrust  back  the  parietal  la3'er  of 
the  peritoneum.  This  swelling  extended  from  the  origin  of  the  coeliac 
axis  as  far  as  the  recto-vaginal  cul-de-sac.  Slightly  behind  its  centre, 
in  the  median  line,  we  discovered  a  narrow  perforation  in  the  peri- 
toneum, through  which  the  blood,  which  had  first  accumulated  beneath 
the  serous  membrane,  had  passed  into  the  abdominal  cavity. 

Examination  of  the  tissues  in  the  lumbar  region  revealed  the  lesion 
responsible  for  the  haemorrhage.  Though  examined  throughout  its 
entire  length  the  vena  cava  showed  no  solution  of  continuity.  The 
walls  of  the  posterior  aorta  were  abnormally  thin,  but  the  perforation 
was  not  at  first  seen.  After  carefully  removing  the  vessel,  we  at  length 
discovered  a  narrow  tear  situated  on  the  superior  surface  opposite  an 
exostosis  on  the  third  lumbar  vertebra.     Opened  along  its  lower  sur- 


THROMBOSIS    OF    THE    ILIAC    ARTERIES    IN    THE    HORSE.  387 

face  the  vessel  showed  two  ulcerations,  the  smaller  about  one  sixth  of 
an  inch  in  length,  resembling  a  scratch  with  the  finger-nail.  Its 
margins  were  sinuous  and  of  irregular  outline;  this  injury  extended 
almost  through  the  entire  thickness  of  the  arterial  wall.  The  other 
ulceration,  which,  like  the  preceding,  occupied  the  dorsal  surface  of  the 
vessel,  offered  the  same  characters,  but  was  larger  (five  sixths  of  an 
inch  in  length  and  one  sixth  in  breadth),  and  was  ruptured  through  its 
base.     Through  this  orifice  the  haemorrhage  had  occurred. 

No  atheromatous  change  could  be  detected  in  the  posterior,  nor  in 
the  common  aorta. 

THROMBOSIS    OF    THE    ILIAC    ARTERIES    IN    THE     HORSE. 

98.  Six-year-old  well-bred  saddle  and  harness  horse,  first  seen  on 
July  24th,  1894. 

History. — Had  been  purchased  about  two  years  previously,  had 
always  seemed  healthy,  and  had  carried  a  rider  through  Yeomanry 
exercises.  For  three  weeks  afterwards  seemed  in  good  health.  Re- 
ported as  having  "  something  seriously  wrong  with  its  back  "  on  July 
24th,  after  being  driven  in  harness.  Had  then  been  quickly  brought 
home. 

State  on  Examination. — Was  "  blowing,"  sweating  profusely  over 
the  entire  body,  and  showed  a  swelling — as  if  from  local  cramp — under 
the  saddle;  movement  stiif ;  pulse  increased,  but  no  fever.  The  disease 
— diagnosed  as  a  mild  attack  of  azoturia — was  treated  by  hot  fomenta- 
tions and  administration  of  a  purgative. 

Complete  recovery  in  a  few  days.  The  horse  was,  however,  only 
exercised,  carefully  dieted,  and  for  a  time  kept  under  observation.  A 
few  days  after  again  returning  to  light  work  it  showed  some  difficulty 
in  moving  the  right  hind  leg,  began  to  blow  and  go  stiff,  and  was 
brought  home.  The  above  treatment  again  resulted  in  recovery.  The 
above  circumstances  recurred  twice,  but  on  the  next  occasion  Mr. 
Rutherford  was  called  in,  and  found  the  animal  in  precisely  the  same 
condition  as  on  July  24th,  but  with  the  addition  to  its  symptoms  of 
very  marked  irregularity  of  the  heart's  action,  from  which  he  concluded 
there  was  obstruction  to  the  aortic  circulation.  The  animal  was 
rested,  the  cardiac  difficulty  disappeared,  and  the  horse  was  sent  to  a 
prospective  buyer  on  trial,  but  was  returned,  having  failed  to  complete 
its  first  journey.  The  alarming  symptoms  then  developed  disappeared 
in  a  day,  but  the  horse  was  noticed  to  pass  very  little  urine,  the  cardiac 
irregularity  had  returned,  and  the  hind  limbs  remained  cold  below  the 
hocks  in  spite  of  bandaging.  The  appearance  and  appetite  were  good  ; 
temperature  normal. 

On  September  nth  Mr.  Rutherford  had  the  horse  ridden,  at  first 
at  a  walk  ;  it  showed  no  symptoms.  When  trotted,  however,  it 
faltered  on  the  right  hind  limb,  over  which  it  lost  control  before  it  had 
gone  500  yards.  The  pace  was  at  once  slowed  to  a  walk,  but  after  a 
few  yards  more  the  left  leg  became  involved,  the  animal  began  to  blow 
and  show  distress,  and  had  great  difficulty  in  covering  the  remaining 
sixty  yards  to  its  stable,  walking  in  a  crouching  manner  "as  if  the  fore 


388  CLINICAL   VETERINARY    MEDICINE    AND    SURGERY. 

and  hind  feet  were  all  at  fault,"  and  was  evidently  in  great  pain.  Im- 
mediately on  entering  its  box  it  lay  down,  the  back  became  swollen  as 
before,  and  the  belly  tucked  up ;  the  animal  groaned  continuously,  and 
sweated  profusely  over  the  body,  fore  extremities,  and  neck.  For  two 
hours  from  this  time  (3  p.m.)  the  animal  remained  in  terrible  and  con- 
tinuous pain,  rolling  occasionally  half  over  on  its  back,  poking  its  nose 
into  its  flanks,  biting  at  its  hind  fetlocks,  and  frequently  attempting 
to  rise.  At  first  it  succeeded,  but  could  not  stand  level,  and  only 
remained  up  long  enough  to  turn  round,  when  it  again  lay  down ;  soon, 
however,  attempting  to  rise  again,  and  on  each  occasion  having  greater 
difficulty  in  doing  so.  Very  soon  it  could  only  rise  high  enough  to  roll 
over  on  its  bent  hind  legs.  Hot  fomentations  were  applied  and 
morphine  given  hypodermically,  under  the  influence  of  which  the 
animal  became  somewhat  quieter,  and  groaned  and  sweated  less, 
though  quite  unable  to  rise.  The  fore  limbs  were  thrown  about  a 
great  deal,  but  the  hind,  which  were  "  deathly  "  cold  from  the  hocks 
downwards,  and  cold  and  insensitive  above,  could  scarcely  be  moved. 
Sweating  was  confined  entirely  to  the  body — in  front  of  the  croup — 
behind  which  the  skin  was  cold  and  dry,  and  the  muscles  showed 
tremulous  movements.  Rectal  exploration  during  a  quiet  period 
revealed  the  existence  of  aortic  and  iliac  thrombi.  The  vessels  were 
resistent  to  gentle  pressure ;  the  aortic  pulse  was  quick  and  thumping, 
and  the  impulse  in  the  internal  iliacs  was  indistinct,  that  on  the  right 
side  being  much  weaker  and  more  indistinct  than  that  on  the  left. 
The  horse  had  always  fallen  lame  on  the  right  leg.  As  the  night 
advanced  the  animal  became  much  quieter :  pain  recurred  at  long 
intervals,  though  it  was  then  severe.  The  case  seemed  hopeless,  but 
morphine  was  again  administered,  and  the  patient  seemed  fairly 
comfortable.  At  3  a.m.,  after  attempting  to  rise,  it  again  became  very 
violent,  lashing  about  with  its  fore  feet,  and  raising  the  fore  part  of  the 
body,  only  to  fall  back  again.  When  seen  at  5  a.m.  it  was  dying  ; 
hind  quarters  and  legs  cold,  submaxillary  pulse  imperceptible.  Died 
at  6  a.m.,  fifteen  hours  after  attack.  The  temperature  never  rose  more 
than  1°  F.  during  the  entire  time. 

Autopsy  disclosed  thrombosis  of  the  termination  of  the  posterior 
aorta,  of  the  right  external  and  internal  iliacs,  and  of  the  left  internal 
iliac  ;  a  patch  of  inflammation  of  the  sublumbar  fascia  above  the  aorta, 
with  exudate ;  and  inflammation  of  the  inner  coats  of  the  vessels 
involved.  The  most  interesting  point  in  connection  with  the  thrombi 
was  that  they  were  apparently  of  different  ages,  the  most  recent  being 
that  of  the  external  iliac,  which  from  its  appearance — a  dense,  fresh 
blood-clot  mainly — was  evidently  the  product  of  the  last  attack. 

Mr.  R.  Rutherford's  case,  Veterinarian,  1895,  p.  35. 
ACUTE    NEPHRITIS. 

99.  Three-year-old  sheep-dog,  left  in  hospital  20th  December,  1893. 

For  some  days  the  animal  had  been  dull,  had  refused  to  eat,  and  at 
times  howled.  Walking  was  difficult,  movement  of  the  hind  limbs 
being  particularly  embarrassed. 


CANCER    OF    THE    KIDNEY.  389 

Next  morning  the  patient  appeared  very  feeble,  and  moved  with 
difficulty.  The  conjunctiva  was  dull  and  infiltrated  ;  the  pulse  85  ;  the 
respiration  slightly  accelerated,  short,  and  sighing.  Nothing  abnormal 
was  discovered  on  auscultating  the  lungs  and  heart.  Manipulation  of 
the  abdomen  was  painful,  especially  towards  the  spine.  Rectal  ex- 
ploration discovered  nothing  abnormal  in  the  pelvic  organs.  Urine 
passed  during  the  night  was  slightly  reddish,  and  contained  about 
forty-five  grains  of  albumen  per  quart.  On  microscopical  examination 
cylindrical  casts,  leucocytes,  a  few  red  blood-corpuscles,  and  some  epi- 
thelial cells  were  discovered  in  it. 

Diagnosis. — Acute  nephritis. 

Treatment. — Milk  diet  and  bicarbonate  of  soda,  emollient  enemata. 

The  animal's  condition  became  rapidly  aggravated.  On  the  24th 
December  the  patient  was  seen  to  be  lame  on  the  right  hind  leg. 
Nothing  could  be  detected  on  examining  the  limb. 

On  the  27th  the  scrotum  became  swollen,  hot,  and  painful.  When 
punctured  reddish  pus  escaped.  Pulse  120,  respirations  28,  tempera- 
ture 39°  C. 

On  the  29th  weakness  was  extreme.  Pulse  130,  respirations  28, 
temperature  40°  C,  The  animal  several  times  took  milk,  but  almost 
immediately  afterwards  vomited.  The  urine  was  very  red  in  colour. 
A  little  discharge  escaped  from  the  nostrils.  In  the  evening  the  pulse 
was  160,  respirations  25,  temperature  ^y^  C.     Died  during  the  night. 

Post-uwrteui  Examination. — The  kidneys  were  large  and  black  in 
colour.  Sections  were  deep  red,  marbled  with  a  few  whitish  points, 
indicating  little  abscesses  distributed  through  the  cortical  and  medullary 
substances.  The  pelvis  of  the  kidney  contained  a  little  purulent  urine. 
The  liver,  spleen,  and  lungs  were  large  and  congested. 

On  microscopic  examination  the  tissue  of  the  kidneys  appeared 
greatly  changed  throughout.  The  glomeruli  and  walls  of  the  tubuli 
were  inflamed.  The  glomeruli  were  filled  with  a  granular  material, 
exuded  between  the  capillaries  and  Bowman's  capsule.  The  tubes 
were  obstructed  by  cylinders,  and  their  epithelium  was  granular.  The 
pericapsular  and  intertubular  connective  tissue  was  infiltrated  with 
migratory  cells.  Sections  coloured  by  Gram's  and  Weigert's  methods 
showed  streptococci  in  short  chains  in  the  capillary  vessels,  in  the 
exudate,  in  the  glomeruli,  and  in  the  tubes.  Others,  surrounded  by 
masses  of  leucocytes,  were  present  at  certain  points  in  the  interstitial 
tissue. 


CANCER    OF    THE    KIDNEY. 

100.  An  eight-year-old  spaniel,  left  in  hospital  19th  March,  1892. 

For  the  preceding  month  it  had  appeared  very  thin,  although  its 
appetite  had  remained  good  until  a  few  days  previous  to  entry,  when  it 
refused  food,  and  remained  continually  lying  down  in  a  moist  corner 
of  the  courtyard,  in  which  it  was  left. 

State  on  Examination. — The  animal  was  very  feeble.  The  muscular 
tissues,  and  especially  the  temporal  muscles,  were  excessively  wasted. 
The  breath  was  offensive.      A   large,  moderately  firm,  subcutaneous 


39°  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

swelling  was  noted  on  the  left  side  of  the  lumbar  region  ;  and  another 
hard,  rounded,  very  large  swelling  on  the  left  side  of  the  inferior 
abdominal  region.  The  abdomen  was  enormous,  and  the  back  was 
depressed.  Temperature  39'4°  C,  pulse  170.  The  respiration, 
though  only  slightly  accelerated  (25  per  minute),  was  irregular  and 
discordant.  The  animal  had  shivering  fits  and  muscular  tremors.  On 
percussion  the  entire  depth  of  both  pulmonary  lobes  showed  partial 
dulness. 

Diagnosis. — Malignant  tumour  in  course  of  generalisation. 

During  the  following  days  no  notable  change  occurred.  The  urine 
was  a  little  darker  than  normal,  and  albuminous.  It  contained  glucose 
or  bile  pigment.  Nothing  could  be  detected  on  rectal  exploration. 
On  counting  the  blood-corpuscles  a  cubic  millimetre  was  calculated  to 
contain — 

Red  blood-corpuscles    ....         8,215,875 
White  blood-corpuscles         .         .         .  19,058 

That  is  a  proportion  of  430  to  i. 

The  owner  was  informed  that  recovery  could  not  be  expected. 
Being  handed  over  to  us,  the  dog  was  kept  until  the  19th  May.  The 
tumours  on  the  back  and  in  the  abdominal  region  increased  in  size, 
and  the  animal  gradually  became  thinner  until  the  day  of  death. 

Autopsy. — Extreme  wasting.  On  removing  the  skin  covering  the 
dorsal  region  an  ovoid,  lobulated  tumour,  as  large  as  a  man's  fist,  was 
found  in  the  longissimus  dorsi  muscle,  which  at  this  point  had  almost 
entirely  disappeared. 

The  left  kidney  was  transformed  into  an  irregular,  ovoid,  bosselated, 
obscurely  fluctuating  tumour,  the  size  of  a  man's  head.  It  was  sus- 
pended by  a  peduncle,  and  floated  in  the  abdominal  cavity,  adhering 
to  the  epiploon.  On  incision  a  brownish-red  liquid  escaped.  After 
escape  of  liquid  the  growth  weighed  thirty-five  ounces.  The  pelvis  of 
the  kidney  was  very  large,  irregular  in  shape,  and  lined  with  inflamed 
mucous  membrane.  An  inch  from  the  depression,  which  represented 
the  hilum,  the  ureter  was  obliterated  and  atrophied. 

The  lower  portion  of  the  left  lobe  of  the  liver  was  deformed  by  a 
soft,  fluctuating  tumour,  the  size  of  a  man's  fist.  Incision  gave  exit  to 
a  brownish  liquid.  The  right  lobe  contained  a  tumour  as  large  as  a 
hazel  nut,  similar  in  appearance  to  the  preceding,  but  which  had  not 
undergone  softening. 

On  opening  the  thoracic  cavity  a  new  growth,  as  large  as  a  pigeon's 
egg,  was  seen  under  the  vertebral  column,  immediately  in  front  of  the 
diaphragm.  The  lungs  were  covered  with  mammilated  tumours  of 
varying  dimensions  and  appearance,  the  largest  the  size  of  a  hazel  nut. 
Nearly  200  were  counted  on  the  different  lobes,  and  sections  revealed 
hundreds  more  in  the  depths.  All  these  new  growths  showed  the  same 
macroscopic  character ;  their  tissue  was  greyish,  friable,  and  full  of 
liquid.     The  bronchial  lymphatic  glands  were  somewhat  swollen. 

On  microscopic  examination  these  tumours  appeared  formed  by 
delicate  connective-tissue  bands  surrounding  alveoli  filled  with  epi- 
thelial cells,  usually  of  small  dimensions. 


DISEASED    PROSTATE    IN    THE    DOG.  39 1 

Inoculation  Test  on  Two  Dogs. — The  tumour  developed  in  the  longis- 
simus  dorsi  muscle  was  kept  in  the  incubator  at  ^y°  C.  until  the 
moment  of  inoculation.  In  the  first  dog  the  lumbar  region  was  shaved 
and  rendered  aseptic.  An  incision,  about  an  inch  in  length,  was  then 
made  through  the  skin,  the  longissimus  dorsi  divided  after  displacing 
the  skin,  a  fragment  of  the  cancerous  tissue  inserted  at  the  base  of  the 
muscular  incision,  and  the  skin  allowed  to  return  to  its  first  position. 
The  wound  was  sutured  with  silk  and  covered  with  collodion.  In  the 
second  animal  the  fragment  of  cancerous  tissue  was  placed  in  the  sub- 
cutaneous connective  tissue. 

Next  day  the  surroundings  of  the  wound  were  slightly  swollen.  No 
suppuration  occurred. 

These  inoculations  remained  sterile.  The  swelling  they  produced 
gradually  diminished,  and  disappeared  entirely  during  the  course  of 
the  third  week. 

[A  case  of  carcinoma  of  the  kidney  is  described  in  section  VII  here- 
after.] 

DISEASED    PROSTATE     IN    THE    DOG. 

loi.   Eight-year-old  bull-dog,  weighing  45  lbs. 

History. — The  development  of  disease  was  gradual  and  very  ill- 
defined.  Structural  changes  had  occurred  long  before  symptoms 
drew  attention  to  them.  During  1894  had  several  attacks  of  constipa- 
tion, accompanied  by  slight  prominence  of  the  anus ;  but  no  marked 
symptoms  occurred  until  three  months  before  death.  An  attack 
accompanied  by  much  straining,  apparently  due  to  impaction  of  faeces, 
then  occurred,  but  after  administration  of  enemata  with  a  long  tube 
suspicion  arose  of  other  complications,  and  careful  examination  revealed 
the  condition  of  the  urinary  organs. 

State  on  Examination. — With  the  abdomen  relaxed  and  a  finger  in 
the  rectum  the  pelvic  swelling  could  be  well  defined,  and  was  obviously 
either  a  prostatic  tumour  or  a  stone  impacted  near  the  neck  of  the 
bladder.  A  limited  area  of  the  tumour  was  calcified,  and  through  the 
abdominal  wall  it  felt  exactly  like  a  stone  about  the  size  of  a  small 
walnut,  connected  with  the  bladder  and  fixed  to  it,  but  not  to  the  spine 
or  pelvis,  except  to  the  extent  to  which  the  bladder  and  prostate  were 
fixed.  An  impacted  stone  producing  much  inflammatory  thickening 
and  a  partially  calcified  prostatic  tumour  would  obviously  have  presented 
similar  or  identical  symptoms ;  the  latter  hypothesis  was  thought  the 
more  probable,  but  the  former  was  not  altogether  excluded.  The  bladder 
was  greatly  distended,  as  was  to  be  expected  ;  but  there  were  peculiar 
features.  In  shape  it  was  very  much  elongated  in  proportion  to  its 
breadth,  passing  high  up  into  the  abdomen,  and  its  contour  was 
broken  by  a  slight  constriction  a  little  above  the  middle,  giving  it 
somewhat  of  an  hour-glass  shape  ;  it  was  not  clear  at  first  whether  this 
constriction  was  due  to  some  fibrous  band  engaging  the  bladder  itself, 
or  to  a  partial  interval  between  a  distended  bladder  and  a  dilated 
kidney ;  but  the  question  was  settled  by  emptying  the  bladder  with  a 
catheter,  when  it  was  found  only  the  lower  part  of  the  tumour  was 
reduced,  and  that  a  soft  fluctuating  tumour  remained  in  the  left  lumbar 


392 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


region,  due  to  a  permanent  hydronephrosis  caused  by  obHteration  or 
closure  of  the  left  ureter.  Catheters  up  to  No.  5  could  be  passed'readily 
when  there  was  no  engorgement  of  the  corpus  spongiosum ;  but  when 
this  was  present  (and  the  irritation  of  the  urinary  organs  was  apt  to 
produce  it)  even  the  smallest  size  would  not  pass  the  groove  in  the 
penile  bone  until  the  hyperaemia  was  relieved  by  a  few  whiffs  of  chloro- 


FiG.  40.—  a.   Prostate,     h.   Bladder,     c.  Thickened  ureter,     d.   Diseased  kidney. 
('.   Hypertrophied  (otherwise  normal)  kidney. 

form.  Human  catheters  were  hardly  long  enough  for  this  bull-dog, 
and  for  a  large  dog  would  have  been  too  short. 

It  was  resolved  to  keep  the  dog  alive  so  long  as  he  enjoyed  his  life 
and  did  not  suffer  much  pain. 

Treatment. — The  bowels  were  regulated  with  gentle  laxatives, 
principally  sweet  oil,  which  was  taken  readily  in  milk  and  kept  the 
motions  soft,  and  unloaded  the  bowels  without  purging  or  straining. 
Occasionally  the  rectum  was  emptied   with  a  warm,  soap-and-water 


DISEASED    PROSTATE    IN    THE    DOG. 


393 


enema  administered  through  an  elastic  catheter,  and  irritation  and  spasm 
were  controlled  by  sedatives  administered  by  the  rectum.  The  drugs 
were  mixed  with  about  a  drachm  of  warm  starch,  and  injected  with  an 
ordinary  glycerine  enema  syringe.  The  most  useful  were  belladonna, 
morphia,  ergot,  cocaine,  and  iodoform.  Ergot  is  the  only  one  not 
generally  recommended  for  this  condition,  but  the  author  regards  it  as 
a  valuable  vascular  sedative,  especially  for  the  genito-urinary  system. 
Two  or  more  of  the  foregoing  were  usually  given  in  combination — a 
dose  at  night,  and  sometimes  one  or  even  two  in  the  day.  By  such 
means  the  dog  was  able  to  keep  its  bladder  empty,  or  nearly  so,  with- 
out much  difficulty  ;  it  had  little  or  no  cystitis,  and  the  urine  was 
never  ammoniacal.  Occasionally  when  the  bladder,  which  was  care- 
fully watched,  became  distended  it  was  emptied  with  a  catheter. 

It  was  decided  if  the  symptoms  could  no  longer  be  kept  in  check 
bv  the  above  means,  that   as  there  was  a  possibility  of  an   impacted 


Fig.  41.— Prostate  of  dog.  General  structure.  x  about  16.  i.  F"ibroid  tissue  infiltrated 
with  cells  and  enclosing  irregular  cavities.  2.  Longitudinal  and  transverse  sections 
of  muscular  bundles. 

stone,  the  abdomen  should  be  opened  above  the  pubes  with  the  strictest 
antiseptic  precautions,  and  if  the  case  proved  hopeless  an  overdose  of 
chloroform  should  be  given  ;  but  if  an  impacted  stone  were  found  it 
should  be  removed  by  a  supra-pubic  lithotomy,  and  the  animal  given 
a  chance  of  recovery. 

It  occurred  to  Mr.  Clarke  that,  considering  the  small  calibre  and 
great  length  of  the  dog's  urethra,  and  the  probability  of  hypera^mia  of 
the  corpus  spongiosum  after  an  operation,  which  would  render  free 
access  to  the  bladder  and  regular  catheterisation  difficult,  it  would  be 
a  great  advantage  to  establish  artificially  a  shorter  route.  A  perinaeal 
listula  is  usually  a  curse  to  its  owner,  but  this  arises  from  the  fact  that 
it  is  usually  associated  with  advanced  vesical  mischief,  loss  of  control 
over  the  sphincter,  and   the  constant   dribbling  away  of  ammoniacal 


394 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


urine.  As  none  of  these  conditions  were  present  in  this  case,  there 
appeared  no  reason  why  a  perinaeal  fistula  should  be  attended  with  any 
of  these  evils,  nor  why  it  should  do  more  than  give  a  dog  a  short  and 
direct  urethra  like  a  bitch.  To  test  this  question  the  following  opera- 
tion was  performed  experimentally  on  a  dog.  Under  ether  the  perinasum 
was  shaved,  a  catheter  passed  into  the  bladder,  and  an  incision  made 
in  the  long  axis  of  the  urethra  down  to  the  catheter  at  the  point  in 
the  perinaeum  where  it  could  be  most  distinctly  felt.  A  longitudinal 
incision  half  an  inch  long  was  made  towards  the  scrotum,  then  bi- 
furcating in  the  shape  of  a  Y  with  the  stem  towards  the  anus.  The 
fork  of  the  Y  was  continued  with  a  slight  curve  to  both  sides,  extending 
altogether  about  two  thirds  of  the  way  round  the  urethra,  and  forming 
two  rounded  flaps.  These  flaps  were  then  stitched  to  the  skin  with  a 
fine  curved  needle  and  horsehair.     Both   the  result  and  the  method 


Fig.  42. —  Prostate  of  dog.  Section  of  portion  of  tumour  where  calcification  is  in  active 
progress.  x  about  65.  i.  Scirrhous  structure,  fibroid  tissue  infiltrated  with  epi- 
thelioid cells.  2.  Calcified  part.  The  calcareous  salts  are  deposited  in  fine  granules 
in  the  fibres,  the  spaces  containing  cells  remaining  in  the  same  condition. 


were  satisfactory,  though  it  might  be  better  to  divide  the  urethra  and 
dissect  half  an  inch  of  it  up.  After  the  operation  a  short  straight 
catheter  could  easily  be  passed  into  the  bladder ;  the  flaps  united  to 
the  skin,  and  the  dog  retained  its  water  without  difficulty  and  passed 
it  through  the  artificial  opening.  The  disease  in  Mr.  Clarke's  dog 
seemed  to  make  very  little  progress  for  rather  more  than  two  months ; 
then  the  animal  began  to  show  signs  of  increased  irritation,  it  passed 
water  more  frequently,  and  could  not  retain  it  all  night,  and  finally  there 
was  an  attack  of  inflammation,  which  gave  rise  to  a  good  deal  of  pain 
which  was  not  controlled  by  sedatives ;  so  having  prepared  sterilised 
dressings,  instruments,  and  ligatures,  and  having  the  kind  assistance 


DISEASED    PROSTATE    IN    THE    DOG. 


395 


of  Mr.  Turner,  Mr.  Clarke  shaved  the  perinseum  and  abdomen,  washed 
them  thoroughly  with  soap  and  hot  water  and  then  with  ether,  covered 
the  abdomen  with  a  towel  wrung  out  in  a  weak  solution  of  bichloride 
of  mercury,  with  a  slit  cut  in  the  towel  corresponding  to  the  proposed 
incision  in  the  skin  ;  sterilised  cotton  wool  for  sponges,  instruments, 
and  ligatures  were  placed  in  warm  saturated  boric  solution,  and  an 
irrigator  with  a  rose  and  tap  was  filled  with  boiled  water  and  suspended 
above  the  table.  Having  given  ether,  the  above-described  perinaeal 
section  was  first  performed  ;  the  abdomen  was  then  opened,  but  as 
soon  as  the  parts  were  exposed  it  was  evident  that  operative  interfer- 
ence was  out  of  the  question,  and  the  dog  was  therefore  killed  with 
chloroform. 

Post-mortem. — A  drawing  of  the  parts  is  given.  The  prostate  was 
much  enlarged,  being  about  the  size  of  a  billiard  ball.  In  the  anterior 
part  was  a  calcified  nodule  as  large  as  a  small  walnut,  and  of  stony 


Fig.  43. — Prostate  of  dog.     Section  of  a  calcified  portion  of  tumour.      x    about  65. 
I.  Fibroid  tissue.     2.  Imperfectly  developed  bone. 

hardness,  and  from  this  point  a  new  growth  had  invaded  the  pelvic 
tissues,  forming  firm  and  extensive  adhesions.  On  section  the  substance 
of  the  prostate  contained  several  cysts  with  semi-purulent  contents ; 
the  termination  of  the  left  ureter  was  involved  and  completely  oblite- 
rated in  a  mass  of  new  growth  of  cartilaginous  consistence ;  the  ureter 
was  dilated  to  the  size  of  a  man's  middle  finger,  filled  with  fluid,  and 
very  thin.  The  left  kidney  was  destitute  of  secreting  structure,  which 
had  been  absorbed  ;  it  was  considerably  dilated,  and  formed  a  sac  filled 
with  fluid,  and  with  walls  scarcely  thicker  than  those  of  the  bladder. 
The  right  kidney  was  hypertrophied,  weighing  more  than  four  ounces. 
The  bladder  was  thickened,  but  the  mucous  membrane  was  normal ; 
the  dog  w^as  fat,  and  all  the  other  organs  were  perfectly  healthy.  Micro- 
scopically the  tumour  presented  a  great  variety  of  structural  changes. 


396 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY 


According  to  Sir  H.  Thompson,  the  enlargements  of  the  prostate 
usually  found  in  eldedy  men  are  (i)  true  hj'pertrophy,  (2)  fibrous  or 
fibro-muscular  hyperplasia,  (3)  glandular  hyperplasia,  and  (4)  simple 
tumours  and  outgrowths.  In  addition  to  these  are  the  cystic  and 
malignant  degenerations.  Primary  cancer  of  the  prostate  is,  however, 
not  common  in  men.  The  prostate  of  this  dog  appeared  to  have  first 
undergone  a  fibro-muscular  hypertrophy ;  the  tumour  was  principally 
of  a  firm  but  spongy  texture,  consisting  on  section  of  fibrous  trabeculae, 
with  numerous  bands  of  muscular  fibres  passing  in  all  directions  and 
enclosing  irregular  spaces,  so  that  to  the  naked  eye  a  section  resembled 
a  section  of  lung ;  upon  this  a  malignant  process  had  supervened,  the 
fibrous  tissue  became  infiltrated  with  epithelioid  cells  forming  groups 
and  masses  in  the  interstices  of  the  fibrous  bands,  extending  into  the 
pelvic  tissues,  and  at  the  anterior  part  of  the  tumour  undergoing  an 


Fig.  44. — Right  kidney  of  dog.  Section  showing  tubules  irregularly  distended  with  swollen 
ceils,  diminishing  or  obliterating  the  lumen  of  the  tubes.  x  about  65.  i.  A  glome- 
rulus with  thickened  capsule. 


imperfect  ossification  ;  there  were  also  several  cysts  in  different  parts 
of  the  tumour.  The  right  kidney,  which  was  hypertrophied,  showed 
signs  of  recent  tubular  nephritis,  not  unlike  the  condition  found  in 
scarlatina  ;  the  tubules  were  swollen  and  irregularly  distended  with 
cells.  The  glomeruli  showed  thickening  of  Bowman's  capsule,  but 
there  was  scarcely  any  areolar  hyperplasia  or  cirrhosis. 

Note  by  Mr.  Clarke. — The  question  arises  whether,  if  the  disease 
had  been  detected  earlier,  it  might  have  been  arrested  by  castration. 
The  difficulty  appears  to  be  to  make  a  sufficiently  early  diagnosis. 

Very  careful  attention  to  urinary  symptoms  in  cases  which  appear 
to  be  only  constipation  would  probably  secure  earlier  recognition, 
though  perhaps  not  early  enough.  Whether  malignant  changes  are 
commoner  in  dogs  than  men  is  at  present  undetermined,  but  unless 


CRYPTORCHID    OPERATIONS.  397 

they  are  usual  it  would  seem  worth  while  trying  the  effects  of  castration 
as  soon  as  any  enlargement  of  the  prostate  was  discovered.  The 
recorded  cases  of  this  operation  in  elderly  men  suffering  from  enlarged 
prostate  have  been  very  favourable.  The  adoption  of  this  mode  of 
treatment  seems  to  have  been  partly  due  to  John  Hunter's  comparison 
of  the  prostate  of  a  bull  with  that  of  a  steer,  and  to  Griffiths,  who 
observed  the  degenerated  condition  of  the  prostate  in  various  animals 
after  castration.  Such  observations  must  be  very  familiar  to  veterinary 
surgeons,  and  probably  many  of  them  are  acquainted  with  the  effects 
of  castration  on  the  prostates  of  different  animals  at  different  ages,  the 
rate  at  which  the  prostate  usually  atrophies  after  operation,  and 
whether  enlargement  or  disease  of  the  prostate  is  ever  known  in  gelded 
animals.  I  do  not  know  whether  any  such  information  is  recorded, 
but  I  have  not  seen  it.*  Dr.  White,  who  was  the  first  to  advise  the 
operation  for  senile  hypertrophy,  argued  that  castration  ought  to  be 
beneficial  by  analogy,  from  the  effect  oophorectomy  in  women  had 
upon  uterine  fibro-myomata.  At  any  rate,  the  operation  has  now  been 
performed  for  the  relief  of  enlarged  prostates  of  old  men  a  good  many 
times,  and  most  encouraging  results  have  been  recorded,  amongst 
others  by  the  following  operators  : 

F.  Ramm  of  Christiania  :  two  cases,  with  good  results.  Ccntralblatt 
fur  Chirurgie,  No.  17,  p.  387,  1894. 

Dr.  Francis  Haynes,  Los  Angeles,  California :  three  cases,  all 
satisfactory.     Buffalo  Med.  and  Surg.  Journal,  March,  1894. 

Fremont  Smith  :  one  case  completely  cured  in  six  weeks.  A  nnah 
of  Surgery,  p.  52,  July,  1894. 

Dr.  Arthur  Powell,  Bengal :  one  case  much  relieved.  Brit.  Med. 
Journal,  November  i8th,  1893. 

Mayer  and  Haenel :  a  bad  case  cured  in  two  months.  Ccniralblatt 
fiir  Ham-  mid  Sex. -Org.,  Band  v,  Heft  7,  1894. 

The  references  are  taken  from  a  resume  by  Mr.  Hurry  Fenwick  in 
the  '  Medical  x\nnual '  for  1895. 

Mr.  R.  H.  Clarke's  case,  Veterinarian,  1895,  p.  431. 

CRYPTORCHID    OPERATIONS. 

102.  A  three-year-old  Percheron  horse,  entered  12th  August,  1892. 

Had  been  bought  two  months  before  in  the  belief  that  he  was  a 
gelding. 

On  examining  the  scrotal  region  no  cicatrix  could  be  discovered. 
Neither  testicle  had  descended.  The  animal  was  prepared  from  the 
I2th  to  the  i8th  August  by  light  diet,  and  internal  administration  of 
three  and  a  half  ounces  of  sulphate  of  soda  daily. 

Operation  was  performed  on  the  right  side  according  to  the  Belgian 
method.  The  horse  was  cast  on  the  left  side,  the  right  hind  limb 
carried  forward  and  kept  abducted  by  means  of  two  strips  of  webbing. 
The  scrotum  and  surrounding  parts  were  most  carefully  disinfected. 

At  the  entrance  to  the  inguinal  canal  we  found  a  rudimentary 
vaginal  sheath  containing  a  portion  of  the  vas  deferens.     The  inguinal 

*   Annals  of  Surgery,   1893. 


398  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

space  was  opened  throughout  its  entire  depth  outside  the  vaginal 
sheath,  and  the  peritoneum  perforated  wath  the  fingers  at  the  spot 
chosen. 

On  exploring  the  preiliac  region  the  epididymis  was  discovered  and 
drawn  into  the  canal.  The  testicle,  which  was  next  withdrawn,  was 
excised  with  the  ecraseur.  All  blood-clot  was  removed  from  the 
wound,  which  was  irrigated  with  sublimate  solution.  No  dressing  or 
suture  was  applied. 

Slight  haemorrhage  occurred  when  the  animal  rose,  blood  escaping 
in  drops  for  several  hours.  During  the  following  days  the  wound  was 
irrigated  with  sublimate  solution.     No  disquieting  symptoms  occurred. 

The  testicle  weighed  two  and  a  quarter  ounces,  was  flattened  and 
flaccid.  On  section  its  tissue  was  seen  to  be  fibrous,  whitish,  and 
marbled  with  blackish  spots  and  lines.  It  was  perforated  with  sinuous 
tracts,  in  which  four  armed  strongyles  were  found. 

On  the  5th  September  operation  was  practised  on  the  left  side. 
Here  the  condition  was  similar.     Treatment  followed  the  same  lines. 

The  left  testicle  weighed  two  and  one  eighth  ounces,  and  resembled 
the  right  in  appearance.  Its  tissue  was  fibrous,  and  traversed  by  irre- 
gular canals,  in  which  we  found  three  strongyles. 

103.  Three-year-old  horse,  left  in  hospital  on  the  loth  May,  1893. 
On  examining  the  scrotum  neither  testicles  nor  cicatrices  could  be 

found.  The  animal  was  prepared  in  the  usual  way  for  six  days.  On 
the  17th  the  Belgian  operation  was  performed. 

The  peritoneum  was  perforated  at  the  base  of  the  inguinal  canal, 
the  tail  of  the  epididymis  seized,  and  the  testicle  having  been  drawn 
into  the  canal  was  removed  with  the  ecraseur ;  haemorrhage  was 
trifling.  The  end  of  the  cord  was  cauterised,  the  wound  irrigated  with 
sublimate  solution,  and  the  lips  brought  together  with  three  cutaneous 
sutures.     The  testicle  weighed  four  ounces. 

The  other  testicle,  found  in  the  inguinal  canal,  was  also  removed 
with  the  ecraseur. 

An  hour  later  the  animal  showed  symptoms  of  trifling  colic,  which, 
however,  passed  oft\     The  evening  temperature  was  38°. 

Next  day  the  sheath  was  a  little  swollen.  The  sutures  were  cut 
and  the  wound  irrigated  with  2  per  cent,  creolin  solution.  During  the 
following  days  the  general  condition  was  good.  The  swelling  above 
the  sheath  increased;  suppuration  was  trifling.  By  the  31st,  i.e. 
fourteen  days  after  operation,  the  wound  had  almost  closed. 

104.  A  four-year-old  half-bred  horse,  left  in  hospital  on  the  loth 
October,  1893. 

Had  been  castrated  in  Normandy.  The  right  testicle  alone  being 
accessible  the  operator  had  confined  operation  to  removing  it.  On 
examining  the  scrotal  region  the  cicatrix  resulting  from  removal  of  the 
right  testicle  was  found ;  none  could  be  felt  on  the  left  side.  After 
several  days'  preparation  operation  was  performed  on  the  i6th  October 
by  the  Belgian  method  under  chloroform. 

The  first  stage  having  been  completed,  the  external  opening  of  the 


CRYPTORCHII)    OPERATIONS.  399 

lower  inguinal  ring  had  to  be  slightly  enlarged  to  allow  the  hand  to 
penetrate.  No  trace  of  the  testicle  was  discovered.  After  examining 
the  inguinal  canal  the  peritoneum  was  broken  through  at  the  point 
chosen.  The  testicle  was  discovered  after  some  moments'  exploration. 
It  was  excised  with  the  ecraseur,  and  found  to  be  very  soft,  flattened, 
and  to  weigh  only  one  ounce. 

A  tampon  of  gauze  was  placed  in  the  opening  of  the  inguinal  canal, 
and  the  cutaneous  wound  brought  together  with  three  interrupted 
sutures. 

That  evening  the  animal's  condition  was  good.  Temperature 
38*8°  C,  respiration  17,  pulse  45. 

Next  day  the  sutures  were  cut,  the  gauze  removed,  and  the  wound 
cleansed  with  warm  sublimate  solution.  On  the  i8th  swelling  was 
marked.  During  the  following  day  it  extended  under  the  belly, 
remained  for  some  time  stationary,  and  then  became  absorbed. 
Suppuration  was  trifling.  The  animal  left  hospital  on  the  4th 
November. 

105.  A  four-year-old  Percheron  horse,  entered  hospital  24th  May, 

On  manipulating  the  scrotal  region  the  left  testicle  could  be  felt. 
The  right  side  of  the  scrotum  was  empty. 

The  animal  was  prepared  for  six  days,  and  operation  performed  on 
the  30th  May  according  to  the  modified  Danish  method.  The  horse 
was  cast  on  the  left  side,  the  right  hind  leg  drawn  into  a  position  of 
abduction  ;  the  scrotal  region  washed  with  soap  and  water,  and  after- 
wards with  an  antiseptic,  while  the  foot  of  the  raised  limb  was  covered 
with  a  moist  cloth. 

The  inguinal  canal  contained  a  rudimentary  vaginal  sheath,  which, 
however,  on  incision  was  found  to  contain  only  a  portion  of  the  vas 
deferens. 

With  the  broad  end  of  a  grooved  director  the  small  oblique  muscle, 
the  transverse  muscle,  and  the  peritoneum  were  perforated  a  little  out- 
side of  and  behind  the  external  commissure  of  the  lower  inguinal  ring  ; 
the  opening  was  afterwards  enlarged  with  the  same  instrument.  The 
right  index  and  middle  fingers  having  been  introduced  into  the 
abdominal  cavity  soon  discovered  and  withdrew  the  testicle,  which 
was  excised  with  the  ecraseur.  Bleeding  was  checked  with  tampons 
of  cotton  wool,  and  the  wound  washed  with  a  solution  of  sublimate. 

The  button-hole  wound  in  the  small  oblique  muscle  was  closed  with 
a  suture,  the  wound  covered  with  gauze,  and  the  skin  brought  together 
with  sutures.     The  testicle  weighed  three  ounces. 

On  the  left  side  castration  was  performed  by  the  covered  operation. 

After-treatment  and  progress  were  as  in  the  preceding  case. 

106.  Four-year-old  Percheron  horse,  entered  hospital  7th  June,  1895. 
The  left  testicle  was  of  moderate  dimensions.     By  examining  the 

inguinal  region  the  right  could  be  felt.  On  rectal  e.xploration  the 
inguinal  ring  was  found  to  be  very  narrow  and  to  be  traversed  by  a 
thin  cord  ;    the  gland  itself  could  not  be  discovered.     The  animal  was. 


400  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

prepared  for  a  week,  and  the  modified  Danish  operation  performed  on 
the  14th. 

The  inguinal  canal  contained  a  rudimentary  vaginal  sheath  enclosing 
a  portion  of  the  epididymis  and  vas  deferens.  The  small  oblique  muscle 
was  duly  divided  and  the  peritoneum  opened.  The  opening  being 
slightly  enlarged  in  the  direction  of  the  muscular  fibres,  two  fingers  were 
introduced  into  the  abdominal  cavity  and  passed  towards  the  upper 
inguinal  ring.  In  a  few  seconds  the  testicle  was  discovered,  seized,  and 
drawn  outwards.  The  traction  on  the  gland  caused  the  parts  contained 
in  the  vaginal  sheath  to  be  drawn  upwards ;  the  epididymis  was 
evidently  astride  the  posterior  border  of  the  small  oblique  muscle. 

The  testicle  was  removed  with  the  ecraseur.  There  was  no 
haemorrhage.  After  closing  the  muscular  breach  with  a  silk  suture  the 
wound  was  cleansed,  the  entrance  of  the  inguinal  canal  filled  with  gauze, 
and  the  scrotal  opening  brought  together  with  three  sutures.  W  eight  of 
the  testicle  one  and  a  half  ounces. 

On  the  left  side  castration  was  performed  by  the  covered  method. 

During  the  afternoon  the  animal  ate  its  food.  In  the  evening  it  was 
a  little  depressed.     Temperature  38'4°  C. 

Next  day  the  sutures  and  dressing  were  removed  and  the  parts 
washed  with  sublimate  solution  ;  temperature  38"8"  C. 

During  the  following  days  the  margins  of  the  wound  became 
swollen,  but  the  pus  was  creamy  and  trifling  in  amount.  The  antiseptic 
dressing  was  continued.     The  temperature  varied  between  37"8°  and 

38-4°  C. 

On  the  28th  the  clams  were  removed.  The  temperature  was  normal. 
From  the  23rd  swelling  diminished,  and  the  wounds  granulated 
actively.     The  animal  left  hospital  on  the  30th  June. 

107.  A  two  and  a  half  year  old  Breton  horse,  left  in  hospital  i6th 
October,  1895. 

On  the  right  side  a  cicatrix  and  the  stump  of  the  cord  could  be  felt ; 
on  the  left  no  cicatrix  and  no  signs  of  a  testicle.  Rectal  exploration 
was  also  unsuccessful. 

The  animal  was  prepared  for  one  week,  and  on  the  23rd  operation 
was  performed  by  the  modified  Danish  method. 

The  small  oblique  muscle  was  freely  exposed  by  tearing  through  the 
aponeurotic  layer  covering  the  external  commissure  of  the  lower 
inguinal  ring,  and  the  muscle  punctured  at  the  usual  point.  Two 
fingers  were  passed  through  the  aperture.  The  testicle  was  at  once 
found,  seized,  and  drawn  outwards  ;  forceps  were  applied  to  the  vascular 
portion  of  the  cord,  and  the  testicle  was  removed  with  the  ecraseur  ; 
on  the  forceps  being  relaxed  no  hsemorrhage  occurred.  Weight  of  the 
testicle  three  and  a  half  ounces. 

The  cord  was  returned  to  the  abdomen,  and  the  opening  in  the  small 
oblique  muscle  closed  by  a  suture.  A  gauze  tampon  was  placed  in  the 
wound,  and  the  skin  brought  together  with  three  interrupted  sutures. 

During  the  afternoon  the  horse  showed  no  signs  of  abdominal  pain, 
and    ate    all    its   food.       Temperature    at    midday    37'g°   C,    evening 

38-4°  c. 


CRVPTORCHID    OPERATIONS.  4OI 

Next  day  the  suture  and  gauze  tampon  were  removed  and  the  parts 
irrigated  with  a  'i  percent,  sublimate  solution.  Temperature,  morning 
^yo)°  C,  evening  38-4°  C. 

On  the  25th  the  animal's  condition  was  excellent ;  temperature, 
morning  38°  C.,  evening  38*4°  C. 

The  sublimate  lotion  was  continued.  During  the  following  days 
the  temperature  never  rose  beyond  38*2°  C.  The  region  of  operation 
became  slightly  swollen,  and  a  little  suppuration  occurred,  but  the 
animal  was  able  to  leave  on  the  6th  November. 

108.  A  five-year-old  horse,  left  in  hospital  15th  May,  i8g6. 

On  exploring  the  inguinal  region  no  testicle  could  be  discovered  ; 
rectal  exploration  was  also  unsuccessful. 

On  the  20th  May  the  modified  Danish  operation  was  performed. 

The  horse  having  been  cast  on  the  left  side,  and  the  right  testicle 
not  being  discovered  in  the  inguinal  canal,  the  small  oblique  muscle 
was  exposed  and  perforated  at  the  usual  point.  The  right  index  and 
middle  fingers  were  passed  into  the  wound,  and  after  a  few  moments 
search  the  epididymis  was  discovered  and  the  testicle  wathdrawn. 
Haemostatic  forceps  were  applied  to  the  cord,  which  was  divided  with 
the  ecraseur.  On  removing  the  forceps  there  was  no  bleeding.  The 
cord  was  returned  to  the  abdomen.  The  wound  in  the  small  oblique 
muscle  was  closed  with  a  single  silk  ligature,  and  the  parts  covered  with 
a  gauze  dressing. 

The  animal  was  then  turned  over ;  the  left  testicle  was  also  in  the 
abdomen.  A  second  operation  was  carried  out  similar  to  the  first. 
The  right  testicle  weighed  three  and  three  quarters,  and  the  left  one 
and  a  half  ounces. 

On  rising,  the  horse  was  taken  back  to  its  box,  and  began  to  eat 
almost  immediately.  No  serious  symptoms  during  the  day ;  evening 
temperature  38*5°  C. 

Next  day  the  sutures  and  dressing  were  removed,  and  the  wounds 
irrigated  with  warm  2  per  cent,  creolin  solution. 

On  the  22nd,  the  animal  ate  all  its  food,  but  appeared  depressed. 
Temperature,  morning  39°  C,  evening  39*2°  C. 

During  the  following  days  the  temperature  varied  between  38"5°  C. 
and  39"5°  C.  There  were,  however,  no  serious  after-symptoms.  Left 
hospital  on  the  30th  May. 

109.  A  six-year-old  Belgian  horse,  entered  hospital  23rd  June,  1896. 
On  rectal  exploration  the  left  testicle  was  found  an  inch  or  two  in 

front  of  the  anterior  border  of  the  ilium.  The  right  testicle  was 
similarly  situated,  slightly  in  front  of  the  anterior  margin  of  the 
pubes. 

On  the  28th,  after  a  preparation  of  five  days,  the  horse  was  castrated 
by  the  modified  Danish  method.  It  was  cast  on  the  right  side,  the  left 
hind  limb  abducted,  and  the  region  disinfected.  An  incision  about 
five  inches  in  length  was  made  over  the  left  inguinal  ring,  the  small 
oblique  muscle  freely  exposed,  and  torn  through  at  the  usual  point  by 
means  of  a  grooved  directer.  The  left  index  and  middle  fingers  were 
introduced  into  the  abdomen,  but  neither  the  testicle  nor  cord  could  be 

c  c 


402  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

felt.  An  assistant  therefore  passed  his  hand  into  the  rectum  and 
thrust  the  organ  from  the  prepubic  region  towards  the  operator's 
fingers.  In  a  few  minutes  the  epididymis  was  seized,  the  testicle  with- 
drawn, forceps  were  applied  to  the  vascular  portion,  which  was  divided 
with  the  ecraseur,  and  returned.  The  lips  of  the  wound  in  the  small 
oblique  muscle  were  brought  together  with  silk.  A  gauze  tampon  was 
placed  in  the  wound  and  fixed  by  sutures  passed  through  the  margins 
of  the  scrotal  incision. 

The  animal  was  turned  over  and  the  same  operation  performed  on 
the  right  side.  On  introducing  the  fingers  into  the  abdominal  cavity 
the  testicle  was  almost  immediately  found,  withdrawn,  and  excised,  and 
the  stump  of  the  cord  returned.  The  operation  was  performed  as  on 
the  opposite  side.  Weight  of  the  left  testicle  two  and  seven  eighths 
ounces  ;  of  the  right,  one  and  three  quarter  ounces. 

During  the  afternoon  the  patient  took  part  of  its  food,  but  in  the 
evening  appeared  depressed.     Temperature  39*1°  C. 

On  the  29th  the  general  condition  was  good.  Temperature  38*3°  C. 
The  sutures  and  dressing  were  removed,  the  wounds  irrigated  with 
warm  creolin  solution,  and  one  and  a  half  ounces  of  bicarbonate  of 
soda  given  in  the  drinking  water.  During  the  day  the  horse  ate  all  its 
food.     Evening  temperature  39°  C. 

Next  day  the  morning  temperature  was  38*4°  C,  evening  tempera- 
ture 38*7°  C.  A  little  subcutaneous  emphysema  was  noted  in  the  flank. 
Treatment  as  on  the  previous  da}-. 

On  the  ist  July  there  was  considerable  swelling  around  the  wound. 
Morning  temperature  38*3°  C,  evening  temperature  38*6°  C. 

From  the  7th  onwards  the  wounds  became  covered  with  granula- 
tions, and  the  oedema  gravitated  towards  the  umbilicus.  The  animal 
left  hospital  on  the  13th  July. 

no.  A  three-year-old  half-bred  horse,  entered  hospital  i8th  October, 
1896. 

This  horse  had  been  castrated  on  one  side  when  about  two  years  old. 
On  manual  examination  of  the  inguinal  region  the  cicatrix  resulting 
from  castration  could  be  felt  on  the  right  side ;  on  the  left  the  testicle 
could  not  be  discovered. 

The  animal  was  prepared  from  the  i8th  to  the  23rd  October,  and 
operated  on  by  the  modified  Danish  method. 

Having  been  cast  on  the  right  side  it  was  fixed  as  usual.  Immedi- 
ately after  perforating  the  small  oblique  muscle  and  peritoneum,  at  the 
moment  when  the  two  fingers  were  passed  into  the  abdomen,  about 
three  pints  of  yellowish  serosity  escaped.  The  testicle  was  easily  found 
and  withdrawn.  It  was  removed  with  the  ecraseur,  and  the  cord 
returned  to  the  abdomen  ;  the  small  oblique  muscle  was  closed  with  a 
silk  suture,  a  gauze  tampon  was  applied  to  the  wound,  and  three 
sutures  were  passed  through  the  skin.  The  testicle  weighed  five  ounces. 

The  animal  was  allowed  to  rise  and  returned  to  its  box.  During 
the  evening  it  ate  its  food.     Temperature  39°  C. 

On  the  24th  October  the  cutaneous  sutures  and  the  gauze  tampon 
were  removed.     Temperature  38*3°  C. 


CRVPTORCHID    OPERATIONS.  403 

During  the  following  days  the  temperature  never  rose  beyond 
38'7°C.  The  animal  left  hospital  on  the  4th  November,  at  which  time 
the  wound  was  about  three  quarters  healed. 

III.  A  five-year-old  Percheron  horse,  entered  hospital  26th  May, 
1898. 

The  right  testicle  had  descended,  but  the  left  was  retained  in  the 
abdomen.  The  animal  was  prepared  from  the  26th  May  to  the  2nd 
June,  and  operated  on  by  the  modified  Danish  method. 

The  testicle  was  found  and  withdrawn  in  a  few  minutes,  and  the 
cord  divided  with  the  ecraseur.  On  the  right  side  castration  was  per- 
formed by  the  covered  method.  The  right  testicle  weighed  two  and 
three  eighths  ounces. 

On  returning  to  its  box  the  horse  ate  part  of  its  food.  The  evening 
temperature  was  39*2°  C.  On  the  3rd  June  the  animal  showed  signs  of 
depression,  and  a  certain  amount  of  emphysema  in  the  right  flank.  The 
dressing  was  removed,  and  the  wounds  irrigated  with  a  i  per  1000 
solution  of  sublimate.  Appetite  was  fair.  Temperature  39*5°  C, 
pulse  40,  respirations  27.  Four  drachms  of  quinine  sulphate,  and 
■5  per  cent,  creolin  enemata  were  given. 

On  the  4th  the  temperature  w^as  39*5°  C,  respirations  36,  pulse 
52.  The  pulse  w^as  feeble,  the  respiration  shallow,  and  expiration 
sighing.  The  animal  ate  part  of  its  food.  The  evening  temperature 
was  41°  C. 

On  the  5th  the  emphysema  in  the  flank  remained  stationary  ;  the 
wound  suppurated  a  little.  Temperature  40*2°  C,  respirations  34, 
pulse  54.  Appetite  was  fair.  Same  treatment.  Evening  temperature 
40-3°  C. 

On  the  6th  the  temperature  was  40*6°  C,  respirations  46,  pulse  54. 
The  creolin  enemata  were  continued.  Four  drachms  of  quinine  sul- 
phate, and  8  ounces  of  sodium  sulphate  were  given  internally. 

On  the  7th  the  patient  refused  part  of  its  corn.  Temperature  40*3° 
C,  respirations  46,  pulse  54. 

A  mustard  plaster  was  applied.  In  the  morning  i  drachm  of 
calomel,  and  in  the  evening  4  drachms  of  quinine  sulphate  were  given. 
The  wounds  were  cleansed  with  sublimate  solution.  During  the  after- 
noon prostration  became  very  marked,  and  expiration  moaning. 
Evening  temperature  40*8°  C. 

During  the  following  five  days  the  condition  remained  stationary. 

On  the  13th  the  temperature  was  39*5°  C,  respirations  35,  pulse 
50.  One  quart  of  i  per  cent,  salt  solution  was  hypodermically  injected, 
andthree  ounces  of  sodium  bicarbonate.fivedrachmsof  quinine  sulphate, 
and  six  quarts  of  milk  given  by  the  mouth.  The  animal  ate  little  and 
showed  signs  of  colic  and  diarrhoea  ;  manipulation  of  the  abdomen  was 
painful. 

On  the  14th  the  general  condition  was  bad.  Morning  temperature 
38'5°  C,  respirations  20,  pulse  44.  One  pint  of  salt  solution  was 
injected.  The  abdomen  was  tapped  at  the  lower  part  of  the  left  flank, 
and  some  quarts  of  a  slightly  turbid  liquid,  which  gave  an  abundant 
deposit,  were  withdrawn.     One  pint  of  salt  solution,  and  four  ounces  of 


404  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 

30  per  cent,  tincture  of  iodine  were  afterwards  injected  by  the  cannula. 
The  evening  temperature  was  39°  C.  Hypodermic  injection  of  one 
pint  of  salt  solution  ;  oral  administration  of  4  drachms  quinine  sulphate, 
ij  drachms  of  laudanum,  and  six  quarts  of  milk. 

On  the  15th  improvement  was  perceptible.  The  animal  had  eaten 
its  food,  and  its  expression  was  brighter.  Temperature  38'6°  C, 
respirations  24,  pulse  48.  The  same  treatment  as  on  the  previous  day 
was  continued. 

On  the  i6th  improvement  was  again  marked.  The  diarrhoea  had 
diminished,  and  the  animal  took  note  of  its  surroundings.  Tempera- 
ture 38"4°  C,  respirations  28,  pulse  40.     Same  treatment. 

On  the  17th  and  i8th  the  appetite  was  good  ;  the  faeces  became 
more  consistent.  Temperature  38*2°  C,  respirations  14,  pulse  40. 
The  injections  of  salt  solution  were  continued,  and  the  oats  increased. 
During  the  following  days  the  last  symptoms  disappeared. 

On  the  23rd  the  temperature  was  normal,  and  the  wounds  had 
almost  healed.  The  animal  left  hospital  on  the  26th,  was  put  to  work 
some  days  later,  and  rapidly  recovered  its  condition  and  strength. 

Remark. — Even  in  solipeds  the  peritoneum  is  fairly  tolerant.  It  is 
well  protected  against  infection,  otherwise  the  mortality  after  intra- 
abdominal operations,  as  usually  practised,  would  be  considerable,  for 
despite  all  precautions  morbid  germs  are  introduced  into  the  peri- 
toneum. But  not  only  are  complications  rare,  but  traumatic  fever  is 
often  very  moderate. 

In  castrating  cryptorchids  it  is  of  the  greatest  importance  to  avoid 
soiling  the  hands,  the  ecraseur,  the  forceps,  or  the  ligatures  applied  to 
the  cord.  If  at  first  the  testicle  cannot  be  found,  the  operator  must 
under  no  circumstances  perform  rectal  exploration,  and  if  an  assistant 
carries  out  this  part  of  the  operation  he  must  not  afterwards  touch  the 
instruments,  especially  the  chain  of  the  ecraseur,  even  though  his 
hands  have  been  washed  and  disinfected.  Against  this  possible  source 
of  inoculation  of  the  operative  wound  special  care  must  be  taken.  The 
peritoneum  may  be  infected  even  though  the  soiling  of  the  operator's 
fingers  occurred  one  or  two  days  previously  if  an  abscess  has  been 
opened  or  a  post-mortem  examination  made.  Under  such  circumstances 
the  fingers  remain  infected  for  two  or  three  days,  even  though  washed 
with  germicide  solutions,  and  unless  the  most  minute  precautions  are 
observed,  asepsis  of  the  veterinary  surgeon's  hands  is  for  this  reason 
almost  always  a  fallacy. 

For  the  past  four  years  I  have  used  the  modified  Danish  method  in 
castrating  cryptorchids  in  my  portion  of  the  hospital.  It  can  very 
readily  be  performed  even  by  the  average  practitioner.  It  is  not  more 
dangerous  than  other  methods,  and  has  the  great  advantage  over  them 
of  allowing  all  the  details  of  the  different  operative  acts  to  be  followed 
visually. 

CRYPTORCHIDISM    IN    THE    CAT. 

112.  A  two-year-old  cat,  left  in  hospital  4th  May,  1898. 
Two  months  before   a  veterinary  surgeon   had   excised   the    right 
testicle.     Somewhat  later  an  unsuccessful  attempt  had  been  made  to 


CANCER  OF  THE  TESTICLE — UNSUCCESSFUL  ATTEMPT  TO  INOCULATE.         405 

remove  the  left,  which  was  retained  in  the  abdomen.     A  ventral  hernia 
had  developed  beneath  the  second  operative  wound. 

On  the  5th  May  the  animal  was  fixed  on  the  table  and  chloro- 
formed. After  disinfecting  the  parts  M.  Almy  made  an  incision  of 
about  three  quarters  of  an  inch  in  the  long  axis  of  the  hernia,  dividing 
the  subcutaneous  tissue  and  afterwards  opening  the  hernial  sac.  The 
left  testicle  was  found  at  the  entrance  to  the  pelvis,  was  withdrawn, 
and  removed  by  torsion.  The  muscular  wound  was  closed  by  inter- 
rupted silk  sutures,  and  the  cutaneous  incision  by  sutures  of  silkworm 
gut.  The  wound  was  painted  with  collodion  containing  salol,  and  the 
abdomen  covered  with  a  dressing. 

On  the  loth  the  dressing  was  removed.  The  wound  only  contained 
a  little  blood-stained  serosity. 

On  the  13th  the  sutures  were  cut  and  removed  :  two  thirds  of  the 
wound  had  healed.  During  the  following  days  the  parts  were  simply 
washed  with  an  antiseptic  solution.  The  animal  left  hospital  on  the 
19th  May. 

CANCER    OF    THE    SCROTUM. 

113.  A  seven-year-old  setter  dog,  left  in  hospital  15th  October, 
1898. 

Had  suffered  for  four  months  from  a  tumour  on  the  scrotum,  which 
had  become  ulcerated,  and  had  been  unsuccessfully  treated  by  cauteri- 
sation with  nitrate  of  silver. 

State  on  Entry. — The  tumour  appeared  as  a  rounded,  reddish  patch 
the  size  of  a  two-shilling  piece,  covered  with  fine  granulations,  slightly 
painful  on  touch,  sharply  defined,  and  with  hardened  margins.  From 
a  distance,  and  at  the  first  glance,  it  resembled  a  patch  of  moist 
eczema,  but  on  closer  examination  its  nature  was  clearly  apparent.  It 
was  in  fact  an  ulcerated  cancer.  The  inguinal  glands  were  not 
infected,  and  the  animal's  general  health  was  good. 

Treatment. — On  the  17th  October  the  tumour  was  removed.  The 
region  having  been  prepared  and  disinfected,  complete  excision,  without 
injury  to  the  deeper  structures  of  the  scrotum,  proved  easy,  as  the  new 
growth  only  extended  to  the  superficial  layer  of  the  dartos  muscle. 
The  lips  of  the  wound  were  united  with  silk  sutures,  and  a  cotton- 
wool dressing,  kept  in  position  by  a  bandage,  was  applied.  Despite 
the  precautions  taken,  the  centre  part  of  the  wound  suppurated,  and 
was  not  completely  healed  until  the  4th  November. 

The  animal  left  hospital  on  the  8th.  Recovery  was  perfect.  There 
was  no  return. 

The  tumour  was  a  lobulated  epithelioma.  Sections  stained  with 
picro-carmine  appeared  formed  of  a  more  or  less  abundant  fibrous 
stroma,  enclosing  masses  of  newly  formed  epithelial  cells  and  epidermal 
"  nests." 

CANCER  OF  THE  TESTICLE— UNSUCCESSFUL  ATTEMPT  TO 

INOCULATE. 

114.  A  ten-year-old  entire  horse,  entered  hospital  on  the  4th  Feb- 
ruary, 1898.  During  the  previous  four  months  the  right  testicle  had 
progressively  increased  in  size. 


4o6 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


At  the  time  of  examination  it  was  as  large  as  a  child's  head,  ovoid 
in  form,  uniformly  hard,  and  bosselated  ;  the  skin  was  moveable  over 
its  surface.  The  lower  portion  of  the  cord  was  swollen,  but  there  were 
no  signs  of  acute  inflammation.  On  rectal  exploration  an  irregular 
tumour,  formed  of  several  lobes  each  the  size  of  a  man's  fist,  was 
discovered  under  the  centre,  and  extending  somewhat  to  the  right  of 
the  sublumbar  region. 

Treatment. — The  animal  having  been  cast  on  Daviau's  table,  the 
testicle  was  removed  with  the  ecraseur.     The  cord,  which  was  found 


Fig.  45. — Epithelioma  of  the  testicle.     Section. 


to  be  little  changed,  was  cut  through  about  three  inches  above  the 
epididymis.  The  operative  wound  healed  without  trouble  and  as 
rapidly  as  after  normal  castration.  The  tumour  weighed  five  and  a 
half  pounds.  On  section  it  appeared  reddish-grey  in  colour,  succulent, 
and  formed  of  lobules  of  varying  size  ;  the  interstitial  connective  tissue 
was  scanty  in  front  and  towards  the  margins,  but  more  abundant  in 
the  centre  (Fig,  45), 

On  microscopical  examination  this  tumour  was  seen  to  be  formed 
of  a  fairly  abundant  fibrous  stroma,  arranged  in  tracts  surrounding 
large  alveoli  filled  with  polyhedral  epithelial  cells.     At  certain  points, 


CANCER  OF  THE  TESTICLE — UNSUCCESSFUL  ATTEMPT  TO  INOCULATE.         407 

where  these  tracts  were  of  some  thickness,  they  contained  hnes  of 
epitheHal  cells. 

With  the  owner's  consent  an  attempt  was  made  immediately  after 
operation  to  inoculate  with  the  new  growth  on  the  left  side  of  the  neck. 
The  skin,  having  been  shaved  and  disinfected,  was  incised  for  a  distance 
of  one  inch,  and  a  small  pocket  formed  by  blunt  dissection,  into  which 
a  fragment  of  the  tumour,  about  three  eighths  of  an  inch  square,  was 
introduced.  The  skin  was  united  with  two  sutures  and  covered  with 
collodion,  protected  by  a  fragment  of  taffeta.  Healing  occurred  by  first 
intention.  The  trifling  swelling  which  formed  disappeared  in  a  few  days, 
leaving  an  indurated  patch,  which  finally  became  entirely  absorbed. 

The  patient  left  hospital  on  the  i6th  February,  and  returned  to 
work  a  few  days  later.  At  first  it  was  brought  back  weekly,  and  later 
once  a  month.  In  spite  of  hard  daily  work,  and  the  fact  that  the 
growth  under  the  lumbar  vertebrae  increased  in  size,  the  animal's  con- 
dition markedly  improved  for  several  months,  and  work  was  continued 
without  interruption  until  the  3rd  November. 

On  that  day  the  animal  was  brought  for  examination  on  account  of 
loss  of  strength  and  appetite.  It  had  worked  as  usual  on  the  previous 
day.  The  symptoms  were  those  common  to  all  wasting  diseases  :  the 
conjunctiva  was  very  pale,  the  pulse  small,  the  circulation  and  respira- 
tion markedly  accelerated,  the  temperature  38*9°  C.  Auscultation  of 
the  heart  revealed  a  systolic  murmur.  On  manipulating  the  abdomen 
peritoneal  exudate  was  recognised.  The  sublumbar  tumour  had 
become  enormous.  The  condition  being  regarded  as  due  to  gene- 
ralisation of  the  cancer  no  treatment  could  be  advised. 

The  animal  returned  home,  and  died  during  the  night.  Next  day 
the  cadaver  was  sent  to  us  for  examination.  The  abdominal  cavity 
contained  a  large  amount  of  blood-stained  exudate,  though  the  large 
vessels  were  normal.  The  intestines  appeared  healthy.  The  upper 
part  of  the  right  spermatic  cord  was  ver}'  large  and  moniliform  (with 
expansions  and  contractions,  like  a  string  of  beads) ;  it  exhibited  a 
chain  of  new  growths,  varying  in  size  between  that  of  a  hazel-nut  and 
a  walnut,  and  extending  as  far  as  the  sublumbar  tumour.  The  latter 
was  sixteen  inches  in  length  by  ten  in  breadth,  and  showed  numerous 
rounded  projections,  some  as  large  as  an  apple.  It  weighed  sixteen 
and  a  half  pounds.  Pyramidal  in  form,  its  base  partly  obstructed  the 
anterior  opening  of  the  pelvis  ;  its  summit,  which  was  slightly  inclined 
towards  the  right,  was  in  contact  with  the  corresponding  kidney ;  its 
upper  surface  adhered  to  the  sublumbar  region;  its  inferior  was 
ulcerated,  and  showed  an  irregular  tear  with  ecchymosed  margins, 
from  which  the  bleeding  had  occurred.  In  front  of  the  tumour  the 
right  ureter  was  dilated  ;  the  walls  of  that  portion  contained  within 
the  tumour  were  hardened  and  thickened,  while  their  lumen  was 
considerably  diminished ;  the  right  kidney  was  slightly  dilated.  The 
left  ureter  was  obliterated,  and  the  corresponding  kidney  showed 
lesions  of  hydronephrosis.  No  secondary  tumours  were  found  in  any 
of  the  viscera. 

[A  case  of  round-celled  sarcoma  of  the  testicle  is  described  in  sec- 
tion VII  hereafter.] 


408  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


SPERMATIC    ANEURISMAL    VARIX     IN    THE    OX. 

115.  Two-year-old  Dutch  bullock  in  prime  condition. 

State  on  Examination.— The  swelling  presented  the  appearance  of  a 
very  large  testicle,  over  which  the  unmistakable  purring  fremitus  and 
humming  bruit  were  well  marked. 

The  scrotum  was  carefully  removed  close  up  to  the  abdominal  wall, 
and  the  artery,  and  from  that  the  vein,  injected  with  wax.  The  dis- 
parity in  size  between  the  artery  and  vein  was  marked.  Each  scrotal 
sac  showed  a  very  visible  castration  cicatrix. 

Note  by  Professor  W alley. — The  origin  of  aneurismal  varix  in  the 
spermatic  vessels  of  the  castrated  animal  is  perhaps  more  easy  of 
explanation  than  in  the  case  of  uncastrated  animals.  It  would  appear 
to  arise  in  much  the  same  manner  as  the  stump  aneurisms  so  familiar 
to  the  surgeon,  /.  c.  a  communication  w^ould  seem  to  be  established 
between  the  severed  ends  of  the  spermatic  vessels  shortly  after  castra- 
tion. At  first  sight  it  might  be  thought  that  the  arterial  influx  would 
be  conveyed  away  by  the  spermatic  vein  without  much  difficulty,  but 
v^hen  it  is  remembered  that  the  arterial  blood  has,  under  normal 
circumstances,  to  pass  through  the  capillaries  of  the  testicle,  and  that 
the  impetus  of  the  arterial  influx  is  thereby  materially  checked,  whereas 
in  such  cases  as  that  under  consideration  it  passes  directly  into  the 
vein,  which  cannot  possibly  convey  it  away  as  quickly  as  it  is  poured  in 
through  the  artery,  it  will  be  seen  that  both  vessels  must  in  the  end 
become  greatly  dilated.  In  due  course  another  factor  in  the  production 
of  distension  is  superadded  in  the  gradual  narrowing  of  the  inguinal 
canal  and  the  abdominal  rings.  In  no  case  have  I  seen  the  dilatation 
extend  beyond  the  external  ring,  showing,  I  think,  conclusively  that 
the  aneurism  has  its  origin  in  obstruction  to  the  venous  flow. 

Prof.  Walley's  case,  Joiirn.  Coiiip.  Path,  and  Therap.,  1894,  p.  68. 

SCIRRHOUS  CORD  WITH  URETHRAL  OBSTRUCTION  IN  THE  HORSE- 
OPERATION— RECOVERY. 

116.  An  aged  chestnut  Clydesdale  gelding,  seen  on  the  17th  March, 
1893. 

History. — Had  difficulty  in  micturition. 

State  on  Examination. — The  animal  made  repeated  attempts  (even 
when  moving)  to  micturate,  but  could  only  pass  small  quantities  of 
urine,  which  continued  to  flow  for  several  minutes  after  each  attempt. 
The  animal  showed  scirrhous  cord  on  the  left  side,  and  a  considerable 
amount  of  dense  tissue  embracing  the  lower  and  lateral  aspects  of  the 
penis,  about  six  inches  from  its  free  extremity,  beyond  which  point  a 
catheter  could  not  be  passed.  On  rectal  exploration  the  bladder  was 
found  greatly  distended. 

On  the  following  day  the  horse  was  cast,  and  the  scirrhus  exposed 
by  dissection,  doubly  ligatured  high  up,  and  removed.  The  dissection 
being  continued  in  a  forward  direction,  the  enlargement  around  the 
penis   was   found    to    be   caused    by   hypertrophy   of  the   suspensory 


NECROSIS    OF    THE    PENIS.  409 

ligament  of  the  sheath.     It  was  removed  by  the  knife.     The  catheter 
was  afterwards  passed  without  difficult}'. 

The  incision  in  the  sheath  was  sutured  and  dressed  antiseptically. 
Considerable  oedema  occurred,  but  soon  subsided.  The  ligature 
sloughed  away  from  the  spermatic  cord,  the  wound  healed,  and  the 
aneursis  gradually  ceased.     Recovery  was  very  satisfactory. 

Prof.  Walley's  case,  yourn.  Conip.  Path,  and  Therap.,  1S93,  p.  361. 

NECROSIS    OF    THE    PENIS. 

117.  Two-year-old  setter  dog,  left  in  hospital  21st  October,  i8g8. 

Daring  the  early  part  of  October  had  been  injured  at  the  base  of 
the  sheath  when  hunting.  In  forty-eight  hours  the  prepuce  became 
greatly  swollen,  rendering  micturition  difficult.  Despite  treatment 
the  symptoms  grew  worse,  and  the  patient  was  sent  to  us. 

Condition  on  Entry. — The  sheath  was  enlarged,  oedematous,  and  its 
right  surface  exhibited  two  suppurating  wounds  from  which  urine 
escaped  during  micturition. 

The  dog  having  been  secured  on  the  table,  an  incision,  two  inches 
in  length,  was  made  along  the  median  line  of  the  sheath,  the  lips 
everted,  and  the  penis,  which  seemed  to  be  necrotic,  exposed.  In 
endeavouring  to  draw  forward  the  penis,  the  free  extremity  ruptured 
opposite  the  anterior  part  of  the  bone  of  the  penis.  This  portion  was 
removed,  some  fragments  of  dead  tissue  still  adherent  to  the  bone  were 
snipped  away  with  scissors,  and  the  bone  itself  slightly  curetted.  The 
parts  were  dressed  with  gau^e,  care  being  taken  to  leave  an  exit  for  urine. 

During  the  night  blood-stained  urine  was  several  times  passed. 
During  the  following  da}s  the  urine  was  expelled  without  difficulty, 
and  the  patient,  though  pre\-iously  thin  and  weak,  recovered  its  strength 
and  condition. 

Treatment. — On  the  4th  Xo\ember  an  inverted  V-shaped  incision 
was  made  over  the  inferior  surface  of  the  sheath,  behind  the  first 
operative  wound  and  o\er  the  bone  of  the  penis,  the  tissues  covering 
the  bone  were  removed,  and  the  urethral  gutter  enlarged  by  means  of 
cutting  forceps.  Although  the  lips  of  the  wound  were  touched  with 
the  actual  cautery,  operation  was  followed  b}-  considerable  haemorrhage, 
which  returned  during  the  night,  and  for  several  days  afterwards  when- 
ever urine  was  voided.  The  patient  left  hospital  on  the  15th  November, 
and  at  once  took  its  usual  place  in  the  pack  of  hounds.  We. recom- 
mended its  being  kept  under  observation  and  returned  if  it  showed 
symptoms  of  contraction  of  the  urethra. 

The  artificial  urinar}-  meatus  contracted  somewhat  rapidly,  and  the 
dog  again  came  into  hospital  on  the  19th  December. 

To  permit  of  urine  being  evacuated  the  urethral  canal  and  the 
tissues  covering  it  were  laid  open  for  a  distance  of  half  an  inch. 
Haemorrhage  was  considerable,  and  for  several  days  recurred  during 
micturition. 

From  the  26th  to  the  30th  December  a  subcutaneous  injection  of 
one  and  a  half  ounces  of  artificial  serum  was  made  daily. 

On  the  6th  January  the  urethral  orifice  was  again  enlarged,  this 


4IO  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

time  opposite  the  posterior  part  of  the  bone  of  the  penis,  the  urethra 
laid  open,  and  the  tissues  covering  it  removed  in  the  shape  of  an 
inverted  V.  To  prevent  further  loss  of  blood  the  lips  of  the  wound 
were  cauterised  without  touching  the  margins  of  the  urethra.  The 
result  of  this  second  operation  was  good  ;  the  urethral  orifice  remained 
permanently  free. 

CANCER    OF    THE    PENIS. 

ii8.  A  twelve-year-old  gelding,  left  in  hospital  15th  January,  1897. 

Had  been  in  its  then  owner's  hands  since  1889.  No  previous 
disease.  A  month  before  the  horse  was  noted  to  have  difficulty  in 
"drawing  the  penis'"  when  staling.  A  veterinary  surgeon,  who  was 
called  in,  discovered  a  tumour  on  the  penis  and  recommended  its 
removal.     The  horse  worked  up  to  the  day  of  entering  hospital. 

At  the  time  of  examination  the  horse  was  in  good  condition,  and 
did  not  appear  to  suffer  from  the  disease.  The  sheath  was  swollen, 
and  discharged  a  little  blood-stained  foetid  pus.  On  introducing  the 
hand  a  hard,  indolent  tumour  was  found  on  the  penis.  When  the 
organ  was  withdrawn  it  appeared  of  large  size,  and  its  lower  third  was 
covered  with  blackish,  friable  cauliflower  vegetations.  The  upper  part 
of  the  new  growth  was  sharply  defined.  Microscopic  examination  of  a 
fragment  showed  it  to  be  ot  a  cancroid  nature. 

r7'^a/;;z^;z/.— Amputation  of  the  penis  above  the  tumour.  On  the 
i8th  the  horse  was  cast  on  the  left  side  and  secured,  as  for  castra- 
tion. The  inguinal  region  having  been  disinfected,  an  elastic  ligature 
was  applied  to  the  base  of  the  penis  to  check  haemorrhage.  Ampu- 
tation was  performed  by  the  method  described  on  p.  61.  On  the 
horse  returning  to  its  stall  some  haemorrhage  occurred,  but  only  in  drops. 

During  the  evening  the  animal  showed  signs  of  trifling  colic.  The 
mucous  membranes  were  slightly  injected ;  the  pulse  accelerated, 
respiration  normal,  temperature  38"5°  C.  Haemorrhage  returned 
during  the  night,  the  blood  escaping  sometimes  by  drops,  sometimes 
in  a  thin  stream.  The  sheath  was  washed  out  with  warm  2  per  cent, 
creolin  solution. 

The  part  of  the  penis  removed  was  five  times  the  normal  size,  and 
covered  with  blackish,  very  friable,  irregularly  arranged  vegetations, 
some  the  size  of  a  hazel  nut,  others  larger  than  a  walnut.  The  urethral 
orifice  was  thrust  towards  the  left  side  and  masked  by  a  large  growth. 
All  the  lower  half  of  the  penis  was  dotted  over  with  little  greyish 
tumours  resembling  papillomata. 

On  the  19th  the  general  condition  was  good.  There  was  no  fever. 
Micturition  was  performed  easily.  The  sheath  was  washed  out  with 
lukewarm  antiseptic  injections. 

Next  day  the  sheath  showed  swelling,  which  increased  for  several 
days.  On  the  26th  it  was  less  swollen  and  sensitive.  On  the  27th  the 
portion  of  the  stump  destroyed  by  the  ligature  separated.  Urine  was 
easily  passed  ;  the  animal  left  hospital  on  the  29th  January.  There  was 
no  after  contraction. 

After  disinfecting  and  scarifying  the  integument  of  the  glans  penis 
in  a  horse  retained  for  experiments,  we  attempted  to  inoculate  the  new 


PARALYSIS    OF    THE    PENIS.  4I I 

growth.  The  scarified  surfaces  were  several  times  rubbed  with  frag- 
ments of  the  tumour,  which  had  been  kept  in  the  incubator  at  38°  C. 
The  result  was  negative. 

iig.  An  eighteen-year-old  gelding,  left  in  hospital  loth  May,  i8g8. 

For  a  long  time  previously  this  horse  had  shown  difficulty  in  urinat- 
ing: it  stretched  out  and  made  efforts,  but  the  penis  did  not  protrude 
beyond  the  sheath,  and  the  urine  escaped  in  a  straggling  stream 
accompanied  by  very  offensive  pus. 

State  on  Examination. — The  scrotum  and  prepuce  were  extremely 
sensitive  to  the  touch.  After  casting  the  horse  the  penis  was  with- 
drawn, and  a  tumour  the  size  of  a  man's  iist,  occupying  the  upper  and 
right  lateral  surfaces,  but  not  affecting  the  urethra,  was  found  on  its 
free  extremity.  This  tumour  was  greyish  in  colour,  ulcerated,  divided 
into  two  lobes  by  a  deep  longitudinal  groove,  and  covered  with  a  thick 
layer  of  offensive  material,  formed  by  pus,  blood,  and  smegma.  Urine 
was  passed  into  the  sheath,  which  was  greatly  inflamed.  The  general 
condition  was  satisfactory,  and  the  functions  of  the  body  normal. 

Treatment. — On  the  19th  May  a  portion  of  the  penis  was  amputated 
by  the  usual  method.  Haemorrhage  was  trifling,  and  was  checked  by 
applying  a  rubber  bandage,  an  inch  below  which  the  penis  was  cut 
through.     Evening  temperature  was  38*5"  C.     The  horse  ate  its  food. 

On  the  20th  and  21st  the  animal  was  depressed,  left  the  greater  part 
of  its  food,  and  showed  signs  of  colic.  The  sheath  was  enormously 
swollen  and  the  stump  of  the  penis  retracted.  Temperature  38*9°  C. 
During  the  next  two  days  the  condition  remained  stationary. 

On  the  25th  the  animal  was  cast  on  the  table.  The  sheath  had 
greatly  contracted,  so  that  the  stump  could  not  be  protruded.  It  was 
laid  open.  The  extremity  of  the  penis  was  slightly  swollen,  the  india- 
rubber  ligature  had  cut  through,  and  the  urethral  wound  was  covered 
with  sebum  and  blood-clot.  The  sheath  was  freely  incised  along  the 
middle  line.  The  somewhat  free  bleeding  which  ensued  was  checked 
by  the  actual  cautery  and  application  of  forceps. 

During  the  following  days  the  stump  was  readily  protruded  previous 
to  staling. 

When  the  horse  left  hospital  on  the  loth  June  the  preputial  and 
urethral  wounds  were  healing  well. 

On  microscopic  examination  the  tumours  in  this,  and  in  the  pre- 
ceding case,  appeared  formed  by  a  connective  tissue  stroma,  and  by 
pavement  epithelial  cells  arranged  in  lobules  of  various  size.  In  the 
small  lobules  the  cells  appeared  actively  growing,  and  stained  readily 
with  carmine  ;  in  the  centre  of  the  larger  the  cells  had  undergone  corni- 
fication,  and  were, arranged  in  epidermal  "nests." 

PARALYSIS    OF    THE    PENIS. 

120.  A  fifteen-year-old  entire  horse,  left  in  hospital  23rd  December, 
1897. 

A  few  days  after  an  attack  of  colic  the  penis  had  remained 
pendent  and  swollen,  and  could  not  be  retracted  into  the  sheath.  It 
was  scarified  and  cold  douches   apphed,   despite  which,   however,   it 


412  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

increased  in  size.  During  the  course  of  the  third  week  of  treatment  the 
animal  was  sent  to  the  College. 

State  on  Examination. — The  penis,  which  was  doubled  in  size  and 
insensitive,  hung  inertly  from  the  sheath.  Its  surface  showed  signs  of 
the  scarification  which  had  been  performed.  The  scrotum  was  slightl}- 
swollen.     There  was  no  fever. 

Until  the  4th  January  the  treatment  consisted  in  :  scarification, 
repeated  cold  spraying,  passage  of  the  electric  current,  and  internal 
administration  of  potassium  iodide.  No  improvement  followed. 
Amputation  was  finally  resolved  on. 

The  operation  was  performed  by  the  usual  method.  The  urethra 
was  exposed,  incised,  and  the  flaps  sutured  to  the  surrounding  integu- 
ment. An  elastic  ligature  was  applied  to  the  penis,  the  free  portion  of 
which  was  divided  just  below.  Haemorrhage  was  somewhat  abundant, 
and  returned  several  times  after  urination.  The  sheath  and  scrotum 
showed  extensive  swelling,  which  persisted  until  the  end  of  the  second 
week,  when  it  began  to  subside.  The  wound  was  cleansed  night  and 
morning  with  warm  creolin  solution,  and  healed  regularl}'.  The  animal 
left  on  the  5th  February.  The  scrotum  and  sheath  were  still  slightly 
swollen,  but  urine  was  freely  passed.     There  was  no  after-contraction. 

121.  An  eight-year-old  gelding,  left  in  hospital  i6th  May,  1898. 

Three  months  before  this  horse  had  suffered  from  pneumonia. 
During  the  period  of  resolution  the  penis  became  paralysed.  One 
morning  it  was  found  swollen,  pendent,  inert,  and  exhibiting  a  sharply 
defined  circular  ridge,  a  few  inches  below  the  margin  of  the  sheath. 
The  condition  was  at  first  treated  by  douches  and  scarification,  but 
unsuccessfully. 

Condition  on  Entry. — ^On  the  day  of  entry  the  protruding  section  of 
the  penis  measured  fourteen  inches  in  length,  was  swollen,  oedematous, 
insensitive,  and  about  three  times  normal  size.  It  showed  scarification 
marks,  some  of  which  still  suppurated,  though  others  had  healed.  The 
sheath  was  slightly  engorged.  The  animal's  general  health  was 
excellent. 

On  the  i8th  May  the  penis  was  amputated  by  the  usual  method. 
A  reversed  V-shaped  incision  was  made  on  the  lower  surface,  each  limb 
being  about  three  and  a  half  inches  in  length.  The  other  stages  of  the 
operation  were  as  usual.  The  excised  portion  of  the  penis  weighed  six 
and  a  half  pounds.  On  the  animal  rising  the  stump  bled,  and 
continued  dripping  for  half  an  hour.  During  the  night  only  a  part  of 
the  ordinary  food  was  consumed. 

During  the  following  days  nothing  noteworthy  occurred.  There 
was  no  haemorrhage,  and  the  temperature  did  not  exceed  38*5°  C.  The 
sheath  swelled,  the  wound  suppurated  slightly,  and  the  gangrenous 
portion  of  the  penis  became  blackish  and  hard.  Urine  was  passed 
without  difficulty. 

At  the  end  of  a  week  suppuration  had  almost  ceased.  The  eschar 
only  held  by  a  narrow  pedicle,  and  on  the  ninth  day  became  separated. 
The  wound  had  healed  and  the  urethra  was  widely  open.  The  animal 
left  on  the  28th  May.     There  was  no  after-contraction. 


PARALYSIS    OF    THE    PENIS. 


413 


This  horse  died  on  the  3rd  May,  1899,  from  rupture  of  the  stomach. 
Fig.  46  shows  the  appearance  of  the  urethral  opening  at  that  time,  i.  e. 
one  year  after  operation. 

122.  A  ten-year-old  entire  horse,  entered  hospital  26th  November, 
1898,  affected  with  paralysis  of  the  penis  consecutive  to  pneumonia. 

On  a  certain  day  during  the  convalescent  period  the  penis  was  seen 
to  remain  pendent.  For  the  following  few  days  it  increased  in  size. 
As  scarification  and  cold  douches  produced  no  benefit  the  horse  was 
sent  to  Alfort  to  undergo  amputation. 

The  animal's  general  condition  was  good.  The  penis  was  insensi- 
tive and  pendulous,  four  times  its  normal  size,  and  marked  with 
transverse  ridges  and  depressions.  The  paralysis  having  only  existed 
for  a  month,  that  is  from  the  26th  November  to  the  4th  December,  was 
at  first  treated  by  local  scarification,  douches,  and  administration  of 


Fig.  46. — Amputation  of  the  penis  showing  stump  and  urethral  orifice. 

potassium  iodide.  The  parts  were  several  times  scarified  at  a  dozen 
points,  haemorrhage  on  each  occasion  being  abundant  and  prolonged. 
Nevertheless,  the  extremity  of  the  penis  only  diminished  slightly  in  size, 
and  remained  paralysed  and  insensitive. 

On  the  5th  December  the  organ  was  amputated  by  the  usual  method, 
though  the  sutures  were  slightly  modified.  The  urethral  canal  having 
been  dissected  free,  cut  transversely,  and  the  exposed  portion  laid  open, 
the  flaps  of  mucous  membrane  were  only  attached  to  the  skin  by  two 
sutures  passed  about  three  eighths  of  an  inch  from  the  margins  of  the 
wound.  The  integument  of  the  penis  was  divided  in  a  circle  opposite 
the  base  of  the  wound,  the  elastic  ligature  drawn  light  in  the  depression 
thus  formed,  and  the  penis  cut  through  about  three  quarters  of  an  inch 
below. 

Despite  the  application  of  the  elastic  ligature  considerable  haemor- 
rhage occurred,  and  had  to  be  checked  by  cauterisation  and  the  appli- 
cation of  forceps.     A  quart  of  one  per  cent,  salt  solution  was  injected 


414  CLINICAL  vp:terinary  medicink  and  surgery. 

into  the  subcutaneous  connective  tissue  of  the  neck.  The  animal  was 
fed  on  ha}'  tea  and  milk. 

A  great  deal  of  blood  having  been  lost  by  scarification,  salt  water 
injections  were  repeated  on  the  three  following  days.  The  extremity 
of  the  penis  was  irrigated  night  and  morning  with  a  warm  antiseptic 
solution. 

Until  the  8th  the  animal  remained  feeble  and  depressed,  and  refused 
part  of  its  food.  Temperature  38"  1°  C.  to  38*5°  C.  On  the  gth  it 
began  to  rail}',  and  each  succeeding  day  improvement  was  more 
marked. 

On  the  13th  the  slough  and  ligature  separated,  the  margins  of  the 
excision  wound  were  covered  with  large  granulations,  but  the  urine 
was  passed  without  difficulty.  Subsequent  progress  was  steady.  The 
animal  left  hospital  on  the  4th  January. 

ATROPHY    OF    THE    PENIS. 

123.  A  twelve-year-old  gelding,  left  in  hospital  28th  May,  1898. 
Soon  after  purchase  this  horse  was  noticed  to  pass  urine  into  the 

sheath,  which  was  inflamed,  enlarged,  and  filled  with  very  offensive 
sebaceous  material.     Micturition  was  slow,  difficult,  and  painful. 

The  horse  was  cast,  fixed  as  for  castration,  and  the  sheath  cleansed 
and  disinfected.  M.  Almy  then  proceeded  to  operate.  There  was 
difficulty  in  passing  the  hand  into  the  sheath  even  for  a  short  distance, 
and  the  penis  could  not  be  discovered.  The  sheath  was  laid  open  for 
a  distance  of  four  to  five  inches  ;  free  bleeding  occurred,  which  was 
checked  by  the  application  of  artery  forceps.  In  spite  of  this  incision 
it  was  still  impossible  to  seize  the  penis.  The  incision  was  therefore 
extended  backwards  for  a  further  distance  of  four  inches.  Finally,  the 
penis  was  discovered  in  an  atrophied  condition. 

The  internal  and  external  integuments  of  the  sheath  were  united 
with  interrupted  silk  sutures  throughout  the  posterior  two  thirds  of 
each  lip  ;  the  anterior  third,  being  inflamed  and  greatly  thickened, 
was  excised.  The  artery  forceps  were  removed,  and  bleeding  vessels 
twisted  or  ligatured. 

Next  day  urine  was  easily  passed,  the  jet  falling  vertically  from  the 
preputial  opening.  The  parts  were  irrigated  with  warm  one  per  thousand 
sublimate  solution. 

During  the  following  days  similar  treatment  was  continued.  Swell- 
ing was  considerable,  but  gradually  diffused  over  the  abdomen  and 
became  absorbed.     Healing  was  rapid. 

The  horse  was  seen  three  months  later.  Operation  had  been 
successful ;  the  head  of  the  penis  remained  sufficiently  exposed,  and 
urine  escaped  in  the  form  of  a  jet. 

CALCULUS    IN    THE    URETHRA. 

124.  The  subject  was  a  cat,  which  had  previously  enjoyed  good 
health.  One  evening,  without  apparent  reason,  it  refused  to  eat, 
appeared  greatly  depressed,  and  hid  away  in  dark  corners.  A  few 
hours  later  it  was  brought  for  examination,  the  history  given  being 


URETHROTOMY    FOR    REMOVAL    OF    CALCULUS    IN    A    HORSE.  415 

that  on  the  evening  when  attacked  it  had  been  played  with  by  some 
children  and  made  to  walk  on  its  hind  legs. 

The  animal  was  very  fat,  and  none  of  the  internal  organs  could  be 
examined.     It  died  on  the  day  of  entering  hospital. 

On  post-mortem  examination  the  peritoneum  of  the  posterior  ab- 
dominal region  and  pelvis  was  found  to  be  inflamed  ;  the  bladder  was 
an  enormous  size,  full  of  turbid  urine,  and  its  walls  were  extremely 
distended  and  inflamed.  It  contained  no  foreign  body,  but  in  the 
urethra,  not  far  from  its  origin,  we  found  a  rounded  calculus  the  size  of 
a  hemp  seed,  which  had  hermetically  sealed  the  passage. 

URETHROTOMY    FOR    REMOVAL    OF    CALCULUS    IX    A    HORSE. 

125.  Six-year-old  cart-horse,  seen  at  midday,  December  15th, 
1894. 

History. — The  horse  was  said  to  have  had  difficulty  in  staling  for  a 
month  or  two  previously ;  at  first  the  urine  had  escaped  in  a  thin 
stream,  afterwards  it  dribbled  away  almost  continuously,  but  on  the 
day  in  question  the  horse  had  not  been  seen  to  stale.  It  perspired 
greatly  at  work,  seemed  easily  distressed,  and  had  once  or  twice 
shown  signs  of  colic  when  returning  from  work. 

State  on  Examination. — ^The  horse  was  perspiring  freely  and  blowing 
a  good  deal.  On  coming  to  a  stop  it  immediately  stretched  out  as 
though  to  urinate,  strained  rather  violently  and  groaned,  but  passed 
no  urine.  The  sheath  was  explored,  the  penis  withdrawn,  and  the 
urethra  examined  by  passing  the  fingers  along  the  lower  surface  of  the 
penis ;  nothing  abnormal  was  discovered.  On  rectal  examination  the 
bladder  was  found  enormously  distended,  so  that  at  first  it  was  pro- 
posed to  tap  the  bladder  with  a  trocar.  It  was,  however,  decided  to 
first  pass  a  catheter.  The  instrument  was  arrested  at  the  point  where 
the  urethra  passes  round  the  ischial  arch.  On  examining  the  intra- 
pelvic  portion  of  the  urethra  it  appeared  distended,  forming  a  kind  of 
band  extending  from  the  bladder  to  just  beneath  the  anus,  where  a 
hard  enlargement,  painful  on  pressure,  was  discovered.  An  impacted 
calculus  being  diagnosed,  urethrotomy  was  performed. 

An  intra-venous  injection  of  morphine  and  atropine  having  been 
given,  the  hind  legs  were  hobbled,  the  catheter  again  passed,  and  the 
perinseal  region  carefully  washed  with  i  in  2000  sublimate  solution, 
which  was  also  used  to  disinfect  the  operator's  hands.  With  an  or- 
dinary scalpel  the  urethra  was  incised  over  the  catheter  ;  the  lips  of 
the  wound  were  retracted,  and  by  exploration  with  the  tip  of  the  fore- 
finger a  rough-surfaced  calculus  was  discovered  about  an  inch  and  a 
half  in  front  of  the  incision.  A  little  melted  vaseline  was  injected,  and 
after  slight  manipulation  the  calculus  was  removed.  A  gush  of  urine 
followed ;  the  writer  estimates  that  in  all  about  two  gallons  and  a 
half  were  voided.  Rectal  exploration  failed  to  detect  any  more 
calculi. 

After  cleansing  with  an  antiseptic  solution  the  wound  was  closed 
with  three  harelip  sutures  and  the  catheter  withdrawn  ;  the  parts  were 
dusted  with  iodoform  and  covered  with  a  pad  of  antiseptic  wool,  re- 


41 6  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

tained  in  position  by  two  strips  of  plaster  bandage,  and  the  whole 
covered  with  a  piece  of  silk,  also  fixed  by  strips  of  plaster.  The  tail 
was  secured  to  the  collar  and  the  animal  tied  up  short.  Slop  food 
and  small  doses  of  potassium  nitrate  were  given.  The  anus,  etc.,  was 
cleaned  three  or  four  times  daily. 

Next  day  urine  was  observed  to  be  dribbling  from  the  sheath — a  fact 
attributed  to  temporary  paralysis  of  the  sphincter  vesicae,  due  to  the 
previous  great  pressure  and  distension.  This  dribbling  ceased  about 
four  days  after  operation.  On  removing  the  dressing  on  the  third  day 
the  wound  appeared  perfectly  healthy,  with  little  swelling ;  the  lips 
seemed  to  be  adherent.  The  pins  were  removed,  the  parts  dusted 
with  iodoform  and,  quickly  covered  with  a  medicated  pad,  secured  as 
before. 

Progress  was  excellent  and  appetite  good.  On  the  sixth  day  the 
horse  urinated  with  apparent  ease.  The  pad  was  removed  from  the 
wound,  which  was  almost  healed,  and  the  horse  was  allowed  to  lie 
down,  precautions  being  taken  against  its  rubbing  the  parts. 

On  December  23rd  the  horse  was  sent  home.  The  catheter  could 
be  readily  passed,  and  there  was  no  evidence  of  stricture.  In  six  weeks 
hardly  any  scar  could  be  seen.  There  was  afterwards  no  sign  of 
difficulty  in  urination. 

The  calculus  was  very  rough  on  the  surface,  measured  seven  eighths 
of  an  inch  in  length,  three  quarters  of  an  inch  in  breadth,  and  five 
eighths  of  an  inch  in  thickness. 

Mr.  E.  C.  Russell's  case,  Veterinarian,  1895,  p.  458. 

NYMPHOMANIA— OVARIOTOMY. 

In  the  mare  the  mortality  from  ovariotomy  has  been  considerably 
reduced  by  asepsis,  and  by  such  simplification  of  the  operative  tech- 
nique as  I  described  in  1888.  Of  fifty-six  mares  which  I  castrated 
between  1888  and  i88g  only  one  died.  This  animal  struggled  very 
violently  when  the  vagina  was  punctured,  and  the  external  iliac  artery 
was  opened  near  its  origin  by  the  blade  of  the  knife.  Of  the  others, 
some  showed  signs  of  abdominal  pain  for  a  few  days,  but  the  majority 
exhibited  very  trifling  post-operative  symptoms.  These  results  confirm 
what  I  stated  as  to  the  tolerance  of  the  peritoneum  when  speaking  of 
castration  of  cryptorchid  horses.  Under  the  ordinary  conditions  of 
veterinary  practice  absolute  asepsis  is  a  myth.  Whatever  the  precau- 
tions observed  in  performing  ovariotomy  the  peritoneum  is  always 
infected  ;  but,  like  all  other  tissues,  it  is  able  to  destroy  the  germs, 
provided  they  be  not  too  numerous  or  too  virulent. 

Of  the  seven  mares  which  I  castrated  during  the  years  1897  and  1898 
one  showed  signs  of  colic,  lasting  for  forty-eight  hours.  Three  of  these 
mares,  which  belonged  to  the  General  Omnibus  Company  of  Paris, 
were  sent  to  the  Alfort  depot  and  operated  on  in  the  School.  M. 
Mouilleron  gave  me  their  after-history.  One  still  remained  excitable, 
came  on  frequently  in  season,  and  had  to  be  drafted.  The  others  were 
returned  to  work  at  the  end  of  a  fortnight,  and  have  not  since  shown 
any  sign  of  nymphomania. 


HYSTERIA    IN    A    MARE.  417 

126.  Eighteen-month-old  female  cat,  left  in  hospital  nth  June, 
1898. 

Qistrum  occurred  very  frequently,  and  for  long  periods.  The 
owner,  Dr.  B — ,  asked  us  to  perform  castration. 

On  the  17th  June  the  ovaries  were  removed  by  M.  Almy.  Chloro- 
form was  administered  by  placing  the  cat  under  a  bell-jar.  When 
anaesthetised  the  animal  was  fixed  in  the  dorsal  position  on  the  table. 

The  middle  line  of  the  abdomen  having  been  shaved  and  disinfected, 
a  longitudinal  incision,  one  and  a  quarter  inches  in  length;  was  made 
along  the  white  line.  The  peritoneum  was  perforated  with  a  blunt 
instrument.  On  drawing  apart  the  lips  of  the  wound  with  retractors  a 
little  firm,  reddish  cord — the  right  uterine  horn — carrying  at  its  ex- 
tremity an  ovary  the  size  of  a  small  pea,  was  at  once  seen.  The  latter 
was  removed  by  torsion  with  artery  forceps.  The  left  uterine  horn  was 
in  turn  discovered,  and  the  corresponding  ovary  removed  in  like  fashion. 
The  muscular  and  skin  wounds  were  sutured,  the  cutaneous  sutures 
covered  with  a  layer  of  collodion,  and  a  cotton-wool  dressing  was 
applied.  During  the  night  the  animal  took  only  a  little  milk  ;  tempera- 
ture 39"3°  C.  Fever  continued  during  the  ensuing  three  days.  Tem- 
perature 39"4°  C. 

On  the  20th  the  dressing  and  cutaneous  sutures  were  removed. 
The  lips  of  the  wound  were  slightly  swollen,  had  united  below,  and 
externally  showed  fine  granulations.  The  parts  were  disinfected  with 
tampons  of  cotton  wool  saturated  with  alcohol.  A  fresh  cotton 
dressing  was  applied. 

Next  day  the  general  condition  and  appetite  were  good.  Tempera- 
ture, morning  387°  C,  evening  39*0°  C. 

On  the  22nd  the  last  signs  of  fever  disappeared.  The  animal  left 
hospital  on  the  25th.     The  wound  was  healed. 

HYSTERIA    IN    A    MARE. 

127.  A  nine-year-old  dark  brown,  well-bred  mare,  about  15  hands 
high,  seen  April  nth,  1886. 

History. — To  improve  the  animal's  condition  it  had  been  recently 
placed  on  a  very  liberal  diet.  On  the  loth  April  it  had  been  driven 
thirty-five  miles. 

State  on  Examination. — The  animal  was  tied  up  short  in  the  middle 
of  a  large  stable,  and  appeared  excessively  uneasy  and  excitable.  By 
stamping  with  the  hind  feet  it  had  formed  a  beaten  semicircular  track 
in  the  straw  ;  the  feet  were  brought  violently  to  the  ground,  the  animal 
occasionally  grabbed  at  the  rack,  and  squealed  like  a  mare  when  shown 
the  stallion.  It  frequently  stopped  in  the  semirotary  movement  and 
stretched  out  as  though  to  stale,  passing  an  ounce  or  two  of  thick 
whitish  urine  ;  each  micturition  was  followed  by  a  very  pronounced 
convulsive  spasmodic  movement  of  the  clitoris.  Small  pieces  of  dung 
were  also  ejected.  The  animal  kicked  at  its  body  and  at  neighbouring 
objects  or  persons,  watching  every  movement,  showing  the  white  of  the 
eye,  laying  the  ears  back  and  kicking  most  viciously.  With  great 
difficulty  a  twitch  was  applied  and  a  side  line  fixed.     On  examining 

D    D 


41 8  CLINICAL    VETERINARV    MEDICINE    AND    SURGERY. 

the  animal  the  conjunctiva  was  found  highly  injected,  the  pulse  quick, 
small,  and  irritable ;  the  skin  tight  ;  the  muscles  of  the  quarters  hard 
and  tense ;  the  anus  retracted  into  the  pelvis  (as  it  is  after  violent  pur- 
gation) ;  the  vulva  relaxed  and  open  ;  the  walls  of  the  vagina  tense  and 
highly  inflamed,  the  vessels  standing  out  prominently  like  tortuous 
cords. 

The  vagina  itself  was  a  large  cavity  in  which  the  hand  could  be 
easily  moved  to  and  fro,  the  walls  appearing  to  be  stretched  to  their 
utmost  limit ;  when  pressed  on  by  the  fingers  and  the  pressure  sud- 
denly relaxed,  a  kind  of  elastic  recoil  occurred.  Air  constantly  passed  in 
and  out  of  the  vagina — there  was,  in  fact,  a  kind  of  vaginal  respiration. 

Treatment. — A  purge  was  given  by  the  mouth,  a  dose  of  morphine 
hypodermically,  and  a  sedative  injected  into  the  vagina. 

On  the  I2th  the  purge  was  acting,  the  appetite  was  in  abe3'ance, 
and  the  animal  only  showed  occasional  attacks  of  excitement. 

On  the  13th  the  excitement  returned  almost  as  severely  as  at  first, 
but  yielded  after  a  sedative  had  been  given. 

During  the  ensuing  five  days  the  appetite  gradually  returned,  the 
attacks  diminished,  and  the  animal  recovered. 

In  another  similar  case  recovery  was  protracted  for  three  weeks,  and 
the  animal  afterwards  retained  the  habit  of  kicking,  so  that  it  was 
sold. 

In  a  third  case,  in  which  the  animal  had  been  served  by  a  stallion 
and  three  days  afterwards  had  performed  a  journey  of  twenty  miles, 
dulness  and  depression  replaced  the  excitement  seen  in  those  above 
mentioned.  The  animal  made  no  resistance  to  examination,  and  when 
moved  remained  standing  inertly  until  its  position  was  again  altered. 
The  pulse  was  full,  regular,  and  forty  per  minute;  the  conjunctiva 
was  injected,  the  eye  glassy,  amaurotic,  and  scarcely  sensitive  to 
light ;  the  temperature  101°  F.  The  condition  of  the  anus,  vulva, 
and  vagina  was  identical  with  that  above  described ;  air  passed  in  and 
out  of  the  vagina,  and  urine  was  frequently  passed  in  small  quantities. 
The  patient  remained  extremely  depressed  and  sluggish  for  four  days  ; 
it  did  not  perfectly  recover  for  a  week  or  two.  The  visit  to  the  stallion 
was  not  repeated,  but  the  animal  proved  to  be  in  foal. 

Note. — Though  the  normal  period  of  oestrum  in  the  mare  does  not 
exceed  three  days,  it  lasted  in  Case  i  about  six  days,  in  Case  2  nearly 
a  month.  In  Case  3  the  sexual  appetite  had  been  gratified,  and 
instead  of  excitement  the  animal  showed  an  almost  cataleptic  condition. 
The  writer  ascribes  the  onset  in  Cases  i  and  3  to  the  highly  stimu- 
lating diet. 

Mr.  G.  E.  King's  case,  Joiirn.  Comp.  Path,  and  Tlierap.,  1893,  p.  69. 

PROLAPSUS    VAGINA    IN    A    YOUNG    MARE. 

128.  A  two  and  a  half  year  old  Clydesdale  mare,  sixteen  hands  high, 
seen  on  August  20th,  1897. 

History. — In  the  autumn  of  1896  had  been  cast  in  the  stable,  as  a 
result  of  which  the  owner  thought  the  animal  had  injured  itself. 
During  the  summer  of  1897,  while  the  mare  was  at  grass,   the  vagina 


PROLAPSUS    VAGIN.«    IN    A    YOUNG    MARE.  .  419 

had  several  times  appeared  prominent,  but  had  not  become  everted  until 
the  above  date  in  August,  1897. 

State  on  Examination. — The  vagina  was  completely  prolapsed,  much 
congested,  and  covered  with  blood.  The  animal  was  in  thin  condi- 
tion, and  the  coat  was  staring.     Temperature  102"  F.     Appetite  good. 

Treatment. — The  animal  was  placed  in  a  stall  and  the  hind  extremi- 
ties elevated  by  a  bank  of  turf.  The  vagina  was  cleansed  with  warm 
I  in  300  creolin  solution. 

On  rectal  examination  a  distinct  bony  ridge  could  be  felt  running 
along  the  pelvic  symphysis,  its  height  being  about  half  an  inch. 

An  attempt  was  made  to  return  the  parts.  Very  little  resistance 
was  offered  until  after  the  vagina  was  adjusted,  when  straining  Became 
so  violent  that  it  was  impossible  to  retain  the  organ  in  position  by  aid 
of  the  hand  and  arm,  A  hypodermic  injection  of  morphia  was  given 
with  no  better  effect. 

The  parts  were  therefore  left  /;/  statu  quo  and  bathed  three  times  a 
day  with  warm  creolin  solution,  for  an  hour  at  a  time.  The  tail  was 
tied  to  one  side,  to  prevent  it  injuring  or  soiHng  the  vagina.  A  ball 
containing  six  drachms  of  Aloes  Barb,  was  given,  and  powders  contain- 
ing each — 

Rad.  Gent.  Pulv Sij. 

Sodae  Hyposulph.     ....       ^iss, 

were  also  left  to  be  given  twice  daily  in  a  bran  mash  or  soft  food. 
The  mare  received  laxative  diet,  like  cut  grass,  etc. 

On  the  third  day  the  organ  returned  to  its  normal  position  spon- 
taneously, and  to  all  appearances  the  mare  had  perfectly  recovered.  A 
tonic  powder  containing — 

Rad.  Gent.  Pulv 5ij, 

Nux  vomica      .         .         .         .         -5]' 

was  given  daily,  and  strict  injunctions  were  given  that  should  the 
animal  be  seen  in  season,  or  the  prolapse  show  the  slightest  reappear- 
ance, the  patient  was  to  be  brought  in  and  placed  in  the  stall. 

On  September  8th  it  was  found  in  the  same  condition  as  on  the 
first  visit.  The  mare  had  come  in  season,  and  the  horses  in  the  sime 
field  had  no  doubt  caused  straining  by  their  excessive  teasing. 

The  same  treatment  as  on  the  first  occasion  was  repeated,  but 
failed.  On  the  sixth  day  the  warm  water  bathing  was  changed  to 
cold.  The  organ  was  bathed  three  times  a  day  for  an  hour  each  time 
with  cold  water,  an  ounce  of  alum  being  added  to  three  gallons  of 
water.  The  water  was  allowed  to  fall  from  a  sponge  upon  the  vagina. 
After  each  bathing  the  parts  were  dressed  with  a  lotion  composed  of— 

Boracic  acid    .....       J^s, 

Tinct.  Opii 3^h 

Aqua ad^xij. 

The  cold  water  treatment  was  continued  for  two  days,  when  the 
mare  began  to  show  symptoms  of  distress.  The  anus  became  relaxed, 
and  on  the  mare  straining,  which  occurred  frequently,  the  rectum 
came  down  to  its  full  extent,  but  returned  when  the  straining  ceased. 


420 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


In  consultation  it  was  agreed  that  as  the  organ  was  still  much 
congested,  and  not  returnable  on  that  account,  and  great  resistance 
was  still  offered  by  the  mare,  a  vertical  incision  should  be  made  on  the 
lowest  point  of  the  inverted  organ  through  the  mucous  membrane  and 
muscular  coats,  leaving  the  serous  coat  intact  to  prevent  protrusion 
of  the  intestines.  This  incision  caused  the  parts  to  diminish  in  size 
on  account  of  the  haemorrhage  that  ensued.     The  region  was  bathed 


J.B.DICKiNSOK 


Anus 


^ff 


.'«-■     ''.-as^ 


<^s  Uren 


incisio 


/Prolapsus  Vegince 


Fig.  47. 


for  a  few  minutes  with  warm  water  containing  a  little  alum,  and 
then  painted  with  Tinct.  Benzoin.  Co. ;  the  treatment  was  repeated 
twice  daily. 

As  considerable  oedema    had    developed    between    the  fore-legs  in 
consequence  of  standing  high  on  the  hind  extremities,  the  mare  was 


CYSTIC    DEGENERATION    OF    THE    OVARY    AND    FALLOPIAN    TUBE.  42 1 

removed  to  a  loose  box  at  night,  and  turned  out  alone  in  a  pasture 
field  during  the  day.     It  received  a  powder  containing — 

Chloral  hydrate        ....       3^5, 
Nux  vom.         .         .         .         .         •       5J> 

given  in  soft  food  twice  a  day. 

This  treatment  was  continued  from  the  i6th  of  September  to  the 
8th  of  October,  by  which  time  the  operation  wound  had  healed.  The 
prolapse  had  considerably  diminished,  and  the  mare  had  greatly  im- 
proved in  condition.     Occasionally,  however,  the  rectum  came  down. 

The  vagina  was  now  adjusted  without  much  difficulty,  and  without 
much  resistance  being  offered.  One  of  West's  prolapsus  clamps 
was  placed  on  the  lips  of  the  vulva.  The  clamp  answered  its  pur- 
pose very  well.  The  rectum  never  again  appeared.  The  mare  now 
received — 

Chloral  hydrate        ....       Jss, 
Nux  vomica     .         .         .         .         •       3J» 

twice  every  alternate  day  for  a  week,  and  was  placed  on  dry  food.  A 
week  after  the  clamp  was  placed  in  position  the  animal  was  occasionally 
sent  out  to  plough  for  half  a  day,  the  clamp  still  remaining  on.  This 
course  was  followed  for  a  month,  when  the  clamp  was  taken  off.  During 
the  ensuing  five  months  there  was  no  indication  of  any  reappearance 
of  the  vagina.     The  mare  appeared  to  have  entirely  recovered. 

Mr.  W.  T.  Hewetson's  case,  Veterinarian,  1898,  p.  83. 

CYSTIC    DEGENERATION    OF    THE    OVARY    AND    FALLOPIAN    TUBE. 

129.  A  ten-year-old  Danish  bitch,  brought  for  examination  on  the 
30th  July,  1897. 

Had  been  punctured  for  ascites  on  four  occasions.  On  the  second 
the  liquid  removed   had   been  blood-stained. 

The  appetite  was  good,  though  the  animal  appeared  emaciated. 
There  was  no  cough,  vomiting,  or  diarrhoea.  On  manipulating  the 
abdomen  a  large  swelling  could  be  detected,  apparently  hanging  from 
the  lumbar  vertebrae.  The  animal  was  again  brought  on  the  17th 
September,  when  it  was  left  to  be  killed. 

Autopsy. — The  abdominal  cavity  contained  several  quarts  of  reddish 
serosity.  With  the  exception  of  the  left  ovary,  the  thoracic  and  abdo- 
minal viscera  were  healthy.  This  ovar}-  was  as  large  as  a  man's  two 
fists,  and  showed  rounded  elevations  and  depressions  of  varying  forms, 
dimensions,  and  consistence ;  the  majority  were  soft,  cystic,  deeply 
tinted  or  blackish,  and  only  covered  by  peritoneum.  Weight  twenty- 
four  ounces. 

On  section  the  central  portion  of  the  tumour  appeared  formed  of  a 
greyish-white,  soft,  friable  tissue,  containing  large  numbers  of  small 
cysts,  which  readily  burst  under  the  pressure  of  the  finger.  The  walls 
of  the  left  Fallopian  tube  were  much  thickened  and  full  of  little  closely 
packed  cysts,  projecting  above  the  mucous  membrane. 

Nothing  abnormal  in  the  uterus  or  vagina. 

On  microscopic  examination  the  tissue  of  the  ovarian  tumour  seemed 


42  2  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

formed  of  a  connective-tissue  stroma,  fibrous  or  sarcomatous  according 
to  the  point  chosen,  and  of  numerous  epitheHal  new  growths,  in  most 
cases  assuming  the  form  of  Httle  cysts,  the  internal  surface  of  which 
was  Hned  with  polymorphic  cells. 

PROLAPSE    OF    THE    UTERUS. 

130.  A  nine-month-old  sheep  bitch,  left  in  hospital  on  the  23rd 
February,  1897. 

Being  always  at  liberty  in  a  courtyard  this  bitch  had  first  come  in 
heat  a  fortnight  before,  and  been  lined.  The  period  of  oestrum  having 
passed,  a  tumour,  the  size  of  a  fowl's  egg,  was  seen  projecting  from  the 
vulva.     For  a  few  days  no  notice  was  taken  of  it. 

At  the  end  of  a  week  the  animal  was  brought  for  examination. 
The  swelling  consisted  of  the  prolapsed  uterus.  It  was  reduced,  and  a 
bandage  supplied,  which,  however,  was  soon  torn  off,  causing  a  recur- 
rence of  the  prolapse  the  same  night.  The  patient  was  therefore  sent 
back  on  the  23rd  April,  1897,  and  left  in  hospital. 

Treatment. — Antiseptic  bathing  of  the  swelling,  which  was  soiled 
with  faeces  and  dust ;  reduction  ;  injection  of  warm  boric  solution  into 
the  vagina  and  warm  enemata.  Ten  minutes  after  the  administration 
of  the  enema  the  bitch  passed  a  large  quantity  of  hard  faeces.  On 
account  of  the  straining  prolapsus  recurred.  It  was  reduced,  the 
parts  irrigated  with  warm  antiseptic  solution,  and  the  vagina  packed 
with  gauze  and  wadding,  care  being  taken  to  leave  uncovered  the 
meatus  urinarius,  so  that  micturition  was  not  interfered  with. 

Next  day  the  tampon  was  found  in  the  straw,  and  the  swelling  had 
returned,  though  it  was  smaller.  Same  treatment  continued.  For 
several  days  following  the  tampons  were,  after  an  interval,  rejected, 
but  the  swelling  on  each  occasion  was  of  less  size. 

On  the  5th  March  the  uterus  no  longer  appeared  externally,  the 
prolapsus  being  contained  in  the  vagina.  After  reduction  the  neck  of 
the  uterus  could  be  clearly  felt. 

On  the  9th  the  vagina  was  empty  and  the  neck  of  the  uterus  closed. 

131.  An  eighteen-month-old  Danish  bitch,  entered  hospital  27th 
April,  1897. 

When  in  heat  the  bitch  had  several  times  previously  suffered  from 
prolapsus  of  the  uterus,  which,  however,  had  yielded  to  simple  reduc- 
tion. This  time  the  prolapsus  was  more  serious.  The  uterus  was 
completely  inverted,  and  formed  a  reddish  mass,  the  size  of  a  man's 
two.  fists,  projecting  from  the  vulva.  Astringent  lotions,  used  to 
diminish  its  size,  had  produced  no  result.  The  animal  was  left  in 
hospital. 

Treatment. — Antiseptic  cleansing  of  the  swelling;  reduction  ;  injec- 
tions into  the  vagina  ;  plugging  of  the  vagina  with  cotton  wool  and 
gauze. 

Next  day  the  tampons  were  still  in  place,  and  were  therefore  not 
interfered  with.  The  patient  was  bright  and  made  no  straining  efforts, 
although  micturition  appeared  a  little  difficult.     The  dressing  was  re- 


IMPERFORATE    VAGINA.  423 

moved  on  the  29th,  on  April  ist,  and  on  the  3rd  of  May.     On  the  5th 
May  recovery  was  perfect. 

Remarks. — Plugging  of  the  deeper  portion  of  the  vagina,  as  practised 
in  these  two  cases,  is  the  best  treatment  for  prolapsus  of  the  uterus  in 
the  bitch.  When  carefully  performed  it  is  well  borne,  and  if  the 
pessary  is  rejected  there  is  no  difficulty  in  renewing  it.  Since  i8g6  all 
cases  of  prolapsus  of  the  uterus  have  been  treated  in  this  w'ay  in  our 
practice.     We  have  never  had  to  practise  amputation. 


MYXOMA    OF    THE    UTERUS. 

132.  A  ten-year-old  bitch,  brought  for  examination  on  the  ist 
February,  1892. 

Two  days  previously  a  large  swelling  had  appeared  below  the  vulva. 
The  last  oestrum  had  occurred  six  weeks  before. 

A  month  before  this  bitch  had  been  seen  to  make  frequent  straining 
efforts  ;  urine  was  passed  frequently,  but  in  small  quantities  ;  the  abdo- 
minal muscles  contracted  violently,  and  remained  contracted  for  a 
certain  time  after  emission  of  urine.  No  treatment  was  adopted  until 
the  2gth  January,  when  a  swelling  was  seen  behind  the  labiae,  which 
was  at  first  regarded  as  "  the  everted  uterus  containing  one  or  more 
young." 

The  swelling  was  partly  covered  by  the  long  hair  of  the  tail,  and  on 
exposure  appeared  ovoid,  smooth,  of  fairly  firm  consistence  and  reddish 
colour  ;  its  upper  part  was  rounded  ;  it  diminished  in  size  towards  the 
base,  which  was  continued  by  a  pedicle  the  size  of  a  lead  pencil,  issuing 
from  the  orifice  of  the  vulva.  It  measured  five  inches  in  length  and 
six  in  circumference.  In  order  to  determine  the  point  of  insertion, 
slight  traction  was  exercised  on  the  growth  ;  the  pedicle  was  fixed  to 
the  right  side  of  the  neck  of  the  uterus,  the  surface  of  implantation 
being  scarcely  one  sixth  of  an  inch  in  diameter.  The  patient  was 
lively,  and  only  seemed  to  have  a  little  difficulty  in  walking. 

The  tumour  was  excised  with  the  knife,  the  base  of  the  pedicle  being 
ligatured  with  silk,  and  the  growth  divided  immediately  behind  the 
ligature. 

The  tissue  of  this  tumour  was  soft,  whitish  towards  the  centre, 
marbled  with  red  towards  the  periphery.  Dotted  through  it  were  little 
cavities  containing  a  reddish  liquid. 

On  microscopic  examination  it  appeared  formed  of  rounded,  fusi- 
form, or  branching  cells,  with  one  or  more  nuclei,  contained  within  a 
highly  refractile,  almost  amorphous  stroma.  Its  peripheral  layer 
contained  considerable  numbers  of  vessels.  It  was  a  myxomatous 
tumour  of  the  variety  known  as  cystic  myxoma. 


IMPERFORATE    VAGINA. 

133.  Four-year-old  bitch,  entered  hospital  on  the  23rd  June,  il 

For  the  previous  week  this  animal  had  been  constipated,  and  made 

violent   attempts   to    defecate.      It    showed    marked   wasting.     From 

between  the  anus  and  vulva  a  fluctuating  swelling  the  size  of  a  large 


424  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

apple  projected,  and  was  at  first  regarded  as  a  perineal  hernia.  On 
introducing  the  index  finger  into  the  rectum,  however,  the  inferior 
surface  of  the  latter  was  found  to  be  compressed  by  a  kind  of  cyst.  The 
patient  was  secured  to  the  table  and  operated  on  by  M.  Almy. 

On  dilating  the  vulva  we  discovered  about  half  an  inch  from  the 
orifice  a  tensely  stretched  mucous  partition,  which  projected  backwards 
and  exhibited  fluctuation.  At  first  it  was  regarded  as  the  distended 
bladder,  or  a  submucous  cyst.  On  passing  a  rubber  catheter  into  the 
bladder,  however,  only  a  little  normal  urine  was  withdrawn.  The 
finger  could  not  be  introduced  into  the  vagina,  the  above-mentioned 
partition  closing  the  entrance.  The  swelling  was  punctured  with  a 
trocar,  when  about  a  pint  of  viscous,  yellowish  pus-like  liquid  escaped. 
The  pocket  was  laid  open  and  part  of  the  partition  removed  with  curved 
scissors.  The  vagina  and  uterus  were  washed  out  with  boiled  water 
until  the  liquid  returned  clear. 

During  the  following  days  the  vagina  was  irrigated  with  boric  acid 
solution.  The  symptoms  noted  before  operation  rapidly  disappeared, 
and  the  bitch  w^as  sent  home  cured  on  the  5th  July. 

AMENORRHCEA    DUE    TO    IMPERFORATE    HYMEN. 

134.  A  "  six-quarter "  Ayrshire  quey  in  fat  condition,  first  seen 
nth  September,  1894. 

History. — Had  been  straining  at  intervals  for  five  days,  the  pains 
daily  becoming  worse.     A  dose  of  physic  had  given  no  relief. 

State  on  Examination. — Appetite  lost  ;  head  depressed,  face  anxious  ; 
the  animal  strained  almost  constantly  and  groaned  loudly  at  intervals. 
During  the  more  severe  pains  about  two  inches  of  the  rectum  in  a 
bleeding  state  were  protruded.  Skin  clammy ;  ears  and  horns  alter- 
nately hot  and  cold.  Temperature  i04'5°  F.  ;  pulse  115,  rather  weak. 
Rectal  examination  revealed  the  presence  of  a  large  ovoid  painful 
swelling  almost  filling  the  pelvic  cavity.  On  exploring  the  vagina  the 
hymen  was  found  to  be  imperforate  and  impossible  to  rupture  by 
manual  exertion. 

Treatment. — After  administration  of  a  full  dose  of  chloral  the 
hymen  was  punctured  with  an  embryotomy  knife,  and  broken  down 
throughout  by  the  fingers.  Four  pints  of  putrid  steel-grey  fluid  con- 
taining whitish  and  reddish  flocculi  were  ejected.  After  washing  out 
the  vagina  with  a  weak  tepid  solution  of  Jeyes'  fluid,  the  os  was  found 
to  be  apparently  normal.  Stimulating  liniment  was  applied  to  the 
croup,  and  chlorodyne  given  internally  to  check  further  straining. 
Pains  entirely  ceased  twelve  hours  after  operation,  and  on  September 
13th  the  quey  was  doing  well. 

Mr.  H.  Begg's  case,  Veterinarian,  1894,  p.  757. 

EPITHELIOMA    OF    THE    VULVA. 

135.  An  aged  cow. 

History. — The  tumour  had  been  noticed  eight  months  previous  to 
the  photograph  being  taken  ;  it  was  then  the  size  of  a  mandarin  orange. 
It  grew  rapidly  and  caused  the  animal  much  inconvenience,  as  shown 


EPITHELIOMA    OF    THE    VULVA. 


425 


by  the  continual  switching  of  the  tail.  The  owner  partially  removed 
it,  but  it  then  grew  even  more  rapidly  than  before.  Operation  was 
first  proposed,  but  was  afterwards  abandoned  owing  to  the  extent  to 
which  the  vagina  was  involved. 

State  on  Examination. — The   surface  of   the  growth   was  raw  and 


Fig.  48. — Cow  with  malignant  epithelioma,  showing  anus  and  vulva  affected. 


bleeding,  and  extended  on  each  side  of  the  vulva  for  three  to  four 
inches,  completely  surrounding  the  labia  with  the  exception  of  the 
lower  commissure,  while   the  inferior   segment  of  the  anus  was  also 


426 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


implicated.  There  were  no  remains  of  healthy  skin  on  the  tumour 
with  the  exception  of  the  external  borders,  where  it  was  being  raised 
by  the  extension  of  the  new  growth  underneath.  The  wall  of  the 
vagina  for  from  six  inches  to  eight  inches  from  the  posterior  extremity 
was  affected,  the  mucous  membrane  being  ulcerated.  The  animal  was 
slaughtered. 

On  post-mortem  many  of  the  lymphatic  glands  of  the  abdomen, 
especially  the  pelvic  and  the  posterior  mesenteric,  were  found  to  be 
affected  with  small  nodules,  consisting  of  greyish-looking  material  of 
soft  consistency.  The  lungs  were  tubercular,  and  the  liver  contained 
a  few  tuberculous  nodules. 

Microscopical  examination  afterwards  demonstrated  conclusively 
that  this  tumour  was  epitheliomatous,  and  also  that  secondary  infection 
of  the  lymphatic  glands  had  taken  place.  The  fact  that  the  animal  w^as 
also  tubercular  is  of  interest  on  account  of  the  extreme  rarity  of  the 
occurrence  of  the  two  conditions  in  the  one  animal. 

Mr.  J.  A.  Gilruth's  case,  Veterinarian,  1900,  p.  294. 


RUPTURE    OF    THE    PERINEUM— OPERATION. 

136.  A  seven-year-old  thoroughbred  mare,  entered  hospital  igth 
October,  1897,  suffering  from  rupture  of  the  perinaeum,  consequent  on 
difficult  labour. 

The  wound  extended  from  the  superior  commissure  of  the  vulva  as 
high  as  the  anus,  without,  however,  affecting  the  sphincter  ani.  It  had 
been  allowed  to  heal  without  surgical  interference.  When  the  mare 
came  in   season  she  was  covered,  but  unsuccessfully,  the  failure  being 

attributed  to  the  rupture.  The  parts  were 
sutured  by  a  veterinary  surgeon.  Adhesive 
union  was  not  obtained,  and  some  months 
later  the  mare  was  sent  to  Alfort. 

State  on  Examination. — General  health 
good.  The  perinseal  rupture,  which  ran  ob- 
liquely upwards  and  towards  the  right,  started 
from  the  superior  commissure  of  the  vulva, 
and  terminated  beneath  the  sphincter  ani. 
The  margins  were  fibrous,  irregular  and  con- 
tracted, and  showed  a  large  opening,  through 
which  a  portion  of  the  faeces  escaped,  causing 
continual  irritation  of  the  vagina. 

Treatment. — Until  the  26th  October  the 
mare  was  prepared  by  injections  of  warm 
boric,  or  one  per  cent,  creolin  solution  re- 
peated twice  daily,  and  internal  administra- 
tion of  three  ounces  of  sodium  sulphate  daily 
in  the  drinking-water.  During  the  last  two 
days  the  animal  was  placed  on  very  low  diet. 
On  the  27th  it  was  cast  on  the  right  side  by 
means  of  the  table.  After  evacuating  the  rectum  the  operative  wound 
was  washed  with  soap  and  water  and  carefully  disinfected. 


Fig.  49. 


CANCER    OF    THE    TAIL — GENERALISATION    AFTER    ABLATION.  427 

The  cutaneous  and  mucous  integuments  were  separated  with  a 
bistoury  throughout  the  entire  length  of  the  tear  for  a  width  of  half  an 
inch.  Haemorrhage  having  ceased,  the  weeping  surfaces  were  freed  of 
the  small  clots  which  covered  them  and  thoroughly  dried.  They  were 
then  united  by  a  double  suture,  which,  although  passing  through  the 
skin  alone,  produced  accurate  coaptation  of  the  internal  surfaces 
(see  figure).  The  first  series  of  sutures  consisted  of  thick  silk  inserted  in 
the  form  of  loops,  the  ends  of  which  were  separated  and  emerged  about 
three  eighths  of  an  inch  from  the  cutaneous  margins  of  the  wound. 
The  second  series  consisted  of  ordinary  interrupted  sutures  of  fine  silk. 
The  object  of  this  second  series  was  to  bring  the  margins  of  the 
integument  into  accurate  contact.  The  vaginal  wound  was  dusted 
with  iodoform  ;  the  cutaneous  wound  touched  with  carbolic  solution, 
powdered  with  iodoform,  and  covered  with  a  strip  of  taffeta. 

On  the  28th  the  parts  were  again  dressed  with  iodoform  and  a  fresh 
strip  of  taffeta.  During  the  following  days  this  treatment  was  con- 
tinued.    There  was  no  suppuration. 

On  the  3rd  November  the  sutures  were  removed ;  union  was 
complete  except  in  the  upper  part  of  the  wound,  where  several  of  the 
deep  sutures  had  torn  away.  As  a  precaution  dressing  with  iodoform 
and  taffeta  was  continued  for  several  days  afterwards.  On  the  24th 
the  animal  was  cast  and  the  upper  margins  of  the  wound  were  again 
operated  on.  The  preparation  and  dressing  were  similar  to  those  in 
the  first  instance. 

On  the  25th  the  taffeta  had  become  loose,  and  was  replaced  by  iodo- 
form collodion  applied  night  and  morning  until  the  30th.  Union  was 
obtained  without  suppuration.  The  sutures  were  removed  on  the  ist 
December.     The  animal  left  hospital  on  the  6th  December. 


CANCER    OF    THE    TAIL— GENERALISATION    AFTER    ABLATION. 

137.  A  nine-year-old  bay-brown  gelding,  suffering  from  tumours  of 
the  tail,  left  in  hospital  on  the  nth  May,  i8g6,  for  removal  of  the  new 
growths. 

The  lower  surface  of  the  tail,  a  hand's  breadth  from  its  base, 
showed  two  sessile  growths  as  large  as  a  walnut,  with  firm,  reddish, 
excoriated  surfaces ;  a  little  in  advance,  but  also  on  the  inferior 
surface,  was  another  growth,  the  size  of  a  hazel  nut,  and  behind  were 
three  growths  the  size  of  a  pea,  around  which  the  skin  was  thickened. 
The  tail  was  swollen.  These  tumours  interfered  with  the  application 
of  the  crupper,  and  were  often  injured  by  it. 

Ablation  was  performed  in  the  standing  position,  the  hind  limbs 
alone  being  hobbled.  The  growths  were  removed  level  with  the  skin 
by  a  single  stroke  of  the  knife.  The  cut  surface  was  curetted,  and 
afterwards  touched  with  the  thermo-cautery.  In  excising  one  of  the 
two  larger  tumours  the  animal  struggled  violently,  and  the  entire 
thickness  of  the  skin  was  divided  for  a  distance  of  one  and  a  half 
inches ;  haemorrhage  was  checked  with  the  hot  iron. 

The  parts  were  covered  with  a  cotton-wool  dressing,  renewed  every 
five  days  for  a  period  of  a  fortnight,  the  wounds  being  dressed  with  30 


428  CLINICAL   VETERINARY    MEDICINE    AND   SURGERY. 

per  cent,  solution  of  iodine  tincture.  On  the  eschars  separating,  the 
wounds  appeared  healthy  and  covered  with  tine  granulations.  The 
horse  was  returned  to  work. 

The  wounds  did  not  completely  heal,  and  the  granulations  soon 
projected  more  than  three  eighths  of  an  inch  above  the  level  of  the 
skin.  Gradually  the  tail  became  swollen,  its  base  doubling  in  size  in 
six  weeks ;  the  swelling  extended  to  the  upper  part  of  the  croup,  in 
which  region  numerous  subcutaneous  tumours  developed.  The  animal 
showed  symptoms  indicating  generalisation  of  the  new  growth,  gradu- 
ally fell  away  in  condition,  and  had  to  be  slaughtered. 

Autopsy. — The  tail  was  of  enormous  size,  asymmetrical  at  its  base, 
the  left  half  being  larger  than  the  right.  On  the  left  side,  a  hand's 
breadth  from  the  anus,  was  a  large  mammillated  patch,  from  which  the 
hair  had  fallen,  formed  by  the  confluence  of  several  tumours ;  it 
extended  to  both  the  upper  and  lower  surfaces  of  the  tail.  Several 
small  tumours  were  included  within  its  area.  The  base  of  the  tail  was 
everywhere  invaded ;  the  skin  and  connective  tissue  being  very 
markedly  thickened.     The  muscles  were  whitish,  hard,  and  sclerosed. 

In  the  subcutaneous  connective  tissue  of  the  croup  and  upper  part 
of  the  quarters,  numerous  rounded,  slightly  flattened,  tumours  were 
found,  the  largest  the  size  of  a  two-shilling  piece.  Most  of  the 
muscles  in  these  regions  were  hardened  or  destroyed  by  the  new 
growths.  The  spleen  was  enlarged  and  bosselated  on  both  surfaces, 
in  consequence  of  the  growth  of  yellowish-white  tumours,  varying  in 
size  between  a  hazel-nut  and  a  man's  fist  :  the  centres  of  some  of  these 
tumours  were  slightly  depressed.  The  liver  was  hypertrophied,  and 
contained  many  small  tumours,  resembling  those  above  described. 
The  surface  of  the  lungs  showed  numerous  whitish  nodules,  and  sec- 
tions displayed  a  dozen  tumours  as  large  as  a  man's  fist. 

On  microscopic  examination  the  tumours  in  the  tail,  muscles,  and 
viscera  showed  the  characters  of  encephaloid  cancer.  Their  tissue 
consisted  of  a  stroma  arranged  in  tracts,  surrounding  spaces  filled  with 
epithelial  cells.  Blood-vessels  were  numerous.  Sections  of  the 
tumours  from  the  tail  showed  in  places  hsemorrhagic  centres. 

Remark. — The  inflammation  caused  by  excision  and  cauterisation 
had  provoked  rapid  diffusion  of  the  new  growths. 


v.— THE    LIMBS. 

OSSIFYING    PERIOSTEAL    SARCOMA    OF    THE    SHOULDER- 
GENERALISATION. 

138.  A  six-year-old  Danish  bitch  entered  hospital  nth  June,  i8g8, 
suffering  from  a  tumour  of  the  shoulder,  which  had  developed  without 
apparent  cause  in  less  than  two  months. 

The  patient  was  extremely  depressed,  and  remained  lying  on  the 
right  side,  apparently  in  acute  pain  ;  at  certain  times  the  respiration 
was  moaning.  As  the  animal  could  not  be  moved  it  was  brought  to 
the  school  in  a  carriage. 

State  on  Examination. — The  entire  left  shoulder  was  greatly  swollen. 

Opposite  the  cervical  angle  of  the  scapula  traces  of  firing  were 
visible.  The  tumour  formed  a  compact,  lobulated,  hard  mass,  not 
painful  on  manipulation,  extending  from  the  central  portion  of  the 
neck  to  the  middle  of  the  thorax  ;  above  it  projected  beyond  the 
shoulder  ;  below  beyond  the  line  of  the  sternum.  Having  developed 
beneath  the  scapula,  which  it  had  thrust  outwards,  it  appeared  to  be 
adherent  to  the  neck  and  trunk.  The  skin  covering  it  was  moveable. 
The  physical  characters  were  those  of  a  sarcoma. 

In  order  to  confirm  the  diagnosis  two  exploratory  punctures  were 
made  into  the  tumour  with  a  trocar,  after  disinfection  of  the  skin. 
From  the  first  puncture,  which  was  made  in  the  upper  lobe,  no  liquid 
escaped  ;  the  point  of  the  trocar  passed  through  friable,  osseous 
tissue,  producing  crepitation.  A  second  puncture,  made  into  the 
inferior  lobe,  below  the  elbow,  gave  exit  to  a  little  blood-stained  liquid. 

Successful  treatment  was  impossible.  The  patient  was  killed  by 
intra-venous  injection  of  chloral. 

Autopsy. — The  upper  portion  of  the  tumour  was  situated  beneath 
the  shoulder.  The  lower  half  of  the  scapula  was  intact,  but  the  upper 
was  infiltrated  by  new  growth.  Detached  from  adjacent  tissues,  the 
tumour  appeared  covered  over  the  greater  portion  of  its  surface  by  a 
thin  fibrous  capsule.  It  measured  eighteen  and  a  half  inches  from 
before  backwards,  seventeen  inches  from  above  downwards,  was  four 
and  three  quarter  inches  in  thickness,  and  weighed  nearly  fourteen 
pounds.  Sections  showed  numerous  interstitial  haemorrhages,  par- 
ticularly in  the  central  part  and  bony  trabeculae.  In  the  spaces 
surrounded  by  these  trabeculae  the  tissue  was  soft,  friable,  greyish  at 
certain  points,  rose-red  or  reddish  at  others,  but  everywhere  very 
vascular.     The  trabeculae  were  numerous  near  the  bone,  but  became 


430  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

rarer  towards  the  surface  ;  the}'  sprang  from  the  inner  aspect  of  the 
upper  third  of  the  scapula,  the  point  of  origin  of  the  tumour.  The 
neighbouring  muscles,  the  ribs,  vertebras,  and  cervical  ligament  were 
not  invaded.  The  connective  tissue  between  the  subscapular  and  large 
serratus  muscles  contained  some  secondary  tumours. 

The  superficial  layers  of  both  pulmonary  lobes  were  dotted  with 
nodules,  varying  in  size  between  a  pin's  head  and  a  walnut,  some 
blackish  and  haemorrhagic,  others  greyish-white,  the  majority  hard  and 
like  the  primary  tumour,  containing  bone  elements.  Sections  showed 
many  new  growths  scattered  through  the  two  lobes.  The  mitral  and 
tricuspid  valves  were  irregularl}-  thickened  by  little  whitish,  very  hard 
nodules. 

Nothing  abnormal  was  discovered  in  the  abdominal  organs. 

On  microscopic  examination  the  primary  and  secondary  tumours 
were  seen  to  be  formed  of  polymorphic  cells,  though  round,  uni-,  or 
multi-nuclear  cells  preponderated.  At  certain  points  an  intermediary 
fibrillated  substance  and  tracts  of  osteoid  tissue  could  be  detected. 


TOTAL  NECROSIS  OF  THE  SCAPULA. 

139.  A  five-year-old  cart  gelding,  sixteen  hands  high,  in  good  con- 
dition. 

History. — Had  gone  lame  a  fortnight  before  examination. 

State  on  Exaniination. — Was  slightly  lame  in  the  near  shoulder.  The 
shoulder  was  bathed  with  hot  water  for  half  an  hour  three  times  daily, 
and  a  lotion  containing  belladonna,  arnica,  and  rectified  spirit  after- 
wards applied. 

The  patient  remained  in  much  the  same  condition  for  about  three 
weeks,  when  it  suddenly  became  very  lame,  dragging  its  leg  behind  it 
in  a  helpless  fashion  when  made  to  walk,  and  evincing  the  greatest 
difficulty  in  passing  over  the  threshold  of  the  stable  door,  apparently 
being  quite  unable  to  advance  the  toe  of  the  foot.  The  same  treatment 
was  continued  for  three  or  four  weeks,  at  the  end  of  which  the  swelling 
pointed  and  burst,  the  opening  resembling  a  small  punctured  wound 
about  half  an  inch  in  length.  By  probing,  the  scapula  could  be  felt, 
and  a  number  of  sinuses  detected  burrowing  in  all  directions  and  filled 
with  pus,  which  gave  off  a  most  offensive  odour.  The  wound  was 
enlarged  by  an  incision  about  four  inches  in  length  above  and  along 
the  vertebral  edge  of  the  scapula.  The  wound  was  thoroughly  syringed 
out  three  times  a  day  with  the  following  : 

Zinci  Chlor.      .         .         .         .         .         .         •     jj- 

Aqua  pura         .......     j^U- 

At  the  end  of  six  weeks,  as  the  case  showed  little  signs  of  improve- 
ment, the  wound  was  opened  sufficiently  to  allow  the  hand  to  be 
inserted  behind  the  bone  ;  on  manipulation  the  superior  portion  of  the 
scapula  could  be  distinctly  made  to  move  backwards  and  forwards, 
giving  the  impression  of  the  superior  third  of  the  bone  being  broken  off 
from  the  inferior  two  thirds.  The  antiseptic  treatment  was  continued. 
Abscesses  now  began  to  form  and  discharge  on  the   muscles  of  the 


TOTAL    NECROSIS    OF    THP:    SCAPULA. 


431 


Fig.  50. — a.  Sequestrum  or  dead  mass.     b.  Case  of  bone  formed  by  the  periosteum. 
c.  Space  filled  with  pus  in  wet  specimen. 


432 


CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 


chest.  These  were  opened,  and  dressed  with  a  i  in  looo  solution  of 
Hydrarg.  Perchlor.  The  animal  remained  in  much  the  same  condition 
for  the  next  few  weeks,  with  the  exception  that  its  general  health,  which 
had  previously  been  excellent,  was  not  quite  so  good.  As,  however, 
signs  of  pyaemia  began  to  manifest  themselves,  the  case  was  considered 
hopeless,  and  the  animal  was  destroyed.  The  injury  was  proved  to  be 
the  result  of  a  kick. 

Post-inoriem  Appearances. — On  dissecting  out  the  scapula  the  bone 
was  found  to  be  surrounded  by  large  quantities  of  very  offensive  pus. 
It  appeared  much  larger  than  normal,  and  was  encased  in  a  sheath  of 
bony  matter,  the  superior  third  being  comparable  to  a  dagger,  the  infe- 
rior two  thirds  to  the  sheath.  After  boiling,  the  specimen  was  found 
to  be  totally  necrosed,  the  bone  forming  a  sequestrum,  with  a  space 
filled  with  pus  between  it  and  the  large  mass  of  new  bony  tissue. 

Mr.  A.  Hodder's  case,  Veterinarian,  1896,  p.  589. 

DISEASE    OF    THE    SCAPULO-HUMERAL    ARTICULATION— NECROSIS 
OF    THE    ARTICULAR    CARTILAGES. 

140.  Clydesdale  gelding,  rising  four  years  old. 

History. — Was  broken  to  harness  in  June,  1897,  and  a  month  later 
fell  lame.  The  condition  was  diagnosed  as  "shoulder-slip"  of  the 
right  shoulder,  the  parts  were  blistered,  and  the  animal  rested.  No 
improvement  occurred.  Somewhat  later  abscesses  formed  in  the  scapular 
region  ;  the  first,  at  the  dorsal  angle  of  the  scapula,  burst  and  discharged 
a   large   amount    of  pus.     (There   were    no    symptoms  of  strangles.) 


Fig.  51. 


Another  formed  behind  the  shoulder-joint,  burst  and  discharged,  healed 
up,  and  again  broke.  Extremely  severe  typical  shoulder-lameness  per- 
sisted. The  entire  shoulder  region  was  diffusely  swollen  and  enlarged, 
and  there  was  no  perceptible  atrophy  of  the  shoulder  muscles.  The 
animal  was  blistered  and  turned  out  to  grass,  but  without  improvement. 
As  recovery  seemed  very  doubtful  the  animal  was  killed. 

Post-mortem  Examination. — The  subcutaneous  fascia  was  found  to  be 
much  thickened,  dense,  and  sclerosed.  The  muscles  covering  the 
dorsum  of  the  scapula  were  almost  entirely  fibrous  throughout  their 


INJURY    OF    THK    FLEXOR    BRACHII    MUSCLE.  433 

extent.  The  tendon  of  origin  of  the  biceps  where  it  plays  over  the 
bicipital  groove  of  the  humerus  showed  signs  of  inliammation,  and  was 
discoloured  upon  the  serous  surface  of  the  tendon,  due  doubtless  to 
extravasation  of  blood  of  long  standing.  The  muscles  in  the  immediate 
neighbourhood  of  the  articulation  contained  numerous  small  abscesses, 
the  pus  being  thick  and  partially  inspissated.  The  most  interesting 
lesions,  however,  were  found  upon  the  articular  surfaces  of  the  scapula 
and  humerus.  The  articular  cartilage  of  the  glenoid  cavity  of  the 
former  was  eroded  to  an  extraordinary  degree,  the  lines  of  erosion  being 
broad  and  deep,  and  coloured  deep  red.  In  one  place  the  removal  of 
cartilage  and  bone  had  progressed  so  far  as  to  produce  a  canal  leading 
from  the  joint  cavity  into  the  cancellated  tissue  of  the  scapula.  Upon 
the  head  of  the  humerus  necrosis  was  also  to  be  seen,  but  not  to  the 
same  extent  as  upon  the  scapula ;  but  here  also  two  perforations  passed 
through  both  articular  cartilage  and  bone  into  the  cancellated  tissue  of 
the  head.  So  far  as  could  be  ascertained  from  the  pieces  of  scapula 
and  humerus  submitted,  there  were  no  abscesses  in  the  bone.  In  con- 
nection with  the  scapula  a  new  deposit  of  bone  had  occurred  just  above 
the  glenoid  rim,  this  being  enveloped  for  two  thirds  of  its  circumference 
by  newly  formed  bone  of  a  spongy  character,  and  somewhat  of  the 
nature  of  a  callus.  (This  may  have  been  the  first  indication  of  an 
ultimate  synarthrosis.) 

Prof.  Metiam's  case,  Veferiiiarian,  1898,  p.  305. 

INJURY    OF    THE    FLEXOR    BRACHII    MUSCLE. 

141.  A  nine-year-old  chestnut  mare,  15.2  hands  high. 

History. — Had  been  fired  over  the  flexor  tendons  of  both  fore-legs, 
and  turned  out  to  grass.  One  morning  the  animal  was  seen  "  hopping  " 
about  the  field  on  three  legs,  showing  excessive  lameness  of  the  near 
fore,  on  which  no  weight  could  be  borne.  This  limb  was  pendulous, 
and  the  hind  limbs  were  brought  far  under  the  body  as  shown  in  the 
figure.  It  was  afterwards  learned  that  the  animal,  when  being  brought 
from  the  field  into  a  straw-yard  with  others,  had  to  pass  through  a 
narrow  gateway,  against  the  post  of  which  it  might  have  been  violently 
thrust. 

State  on  Examination. — There  was  no  local  heat,  pain,  or  swelling, 
but  as  the  case  appeared  to  have  existed  for  some  time,  and  such 
symptoms  might  have  disappeared,  a  stimulating  application  was  made 
to  the  muscles  of  the  shoulder  and  to  the  shoulder-joint.  Little  benefit 
resulted.  A  smart  cantharides  blister  was  then  applied.  The  limb 
continued  to  contract,  the  muscles  of  the  shoulder  to  atrophy,  and  the 
spine  of  the  scapula  to  appear  more  prominent.  As  the  animal  seemed 
to  be  steadily  growing  worse,  it  was  shot  eight  weeks  after  being  first 
seen. 

Post-mortem  Examination. — On  removing  the  affected  limb  from  the 
trunk  the  muscles  of  the  shoulder  were  found  to  be  much  atrophied, 
and  those  on  the  inner  aspect  of  the  limb  and  corresponding  outer 
aspect  of  the  chest  wall  bore  large  emphysematous  patches.  No  sign 
of  fracture  of  any  of  the  ribs  could  be  detected.     An  extravasation  five 

E  E 


434 


CLINICAL    VETKRINARY    MEDICINE    AND    SURGERY. 


inches  in  diameter  was  observable  opposite  the  internal  surface  of  the 
fourth  rib  of  the  right  side.  The  lungs  appeared  healthy,  with  the 
exception  of  some  signs  of  haemorrhagic  infarction  about  their  root. 
The  pericardium  was  distended,  and    upon  making    an  incision    was 


Fig.  52. —  Inflammation  of  the  bursa  of  the  biceps,  flexor  brachii,  or  coraco-radialis  muscle, 
with  pericarditis  and  hypertrophy  of  the  heart.  The  near  fore-limb  is  slightly  flexed  and 
swung  behind  the  off  fore-limb.  The  muscles  of  the  shoulder  are  atrophied,  and  the 
horn  of  the  toe  is  worn  away. 

found  to  contain  a  quantity  of  inflammatory  fluid.  On  removing  the 
heart  and  washing  out  the  chambers  it  was  placed  on  the  scales,  and 
weighed  lo^  lbs. 

Mr.  A.  Hodder's  case,  Veterinarian,  1897,  p.  147. 


FRACTURE    OF    THE    HUMERUS    IN    A    HORSE. 

142.  A  nine-year-old  harness  mare,  14.2  hands  high. 

History. — Had  run  away  while  attached  to  a  gig,  come  in  violent 
contact  with  a  wall,  and  fallen  on  the  left  shoulder.  On  regaining  its 
feet  the  animal  was  very  lame. 

State  on  Examination. — The  animal  stood  on  three  legs  ;  the  affected 
limb  was  flexed  from  the  knee  downwards,  and  hung  pendulous. 
Crepitation  could  be  detected  over  the  region  of  the  humerus.  The 
leg  could  readily  be  drawn  far  outwards  from  the  surface  of  the  body, 
and  when  released  swung  inertly  back.  The  animal  did  not  appear 
in  excessive  pain,  and  remained  perfectly  quiet  ;  respiration  was  not 
accelerated. 

Diagnosis. — Fracture  of  the  humerus. 


PENETRATING    WOUND    OF    THE    ELBOW.  435 

The  animal  was  killed. 

Autopsy  (made  immediately  after  death).— The  muscles  surrounding 
the  humerus  were  much  bruised  and  infiltrated  with  blood  ;  the  bone 


Fig.  53. 

itself  had  sustained  a  comminuted  fracture,  and  was  broken  into  seven 
pieces. 

.Mr.  A.  Hodder's  case,  Veterinarian,  1898,  p.  240. 

PENETRATING    WOUND    OF    THE    ELBOW. 

143.  An  eight-year-old  gelding,  entered  hospital  March  2gth,  i8g8. 

While  drawing  a  cart  on  the  previous  evening,  the  horse  had  fallen 
from  a  height  of  twenty-two  feet  into  a  barge  in  the  Seine.  The  left 
shaft  of  the  vehicle  broke  off  obliquely,  the  sharp  end  penetrating 
between  the  olecranon  and  thorax,  passing  through  the  subscapular 
region,  and  emerging  in  front,  near  the  point  of  the  shoulder.  It  was 
at  once  removed. 

Condition  on  Entry. — Just  inside  the  point  of  the  left  shoulder  was  a 
large  irregular  wound  about  twelve  inches  long,  extending  obliquely 
downwards  and  inwards,  the  lower  part  only  affecting  the  skin  and 
connective  tissue,  the  upper  part  traversing  the  fibres  of  the  mastoido- 
humeralis  muscle  ;  the  caput  muscles  were  hardly  affected.  At  the 
lower  angle  of  this  first  wound  was  a  deep  cul-de-sac  filled  with  coagu- 
lated blood.  The  wound  traversed  the  connective  tissue  in  the  axillary 
space,  the  superficial  pectoral  muscle  (in  the  direction  of  its  fibres)  and 
ended  over  the  upper  part  of  the  inner  surface  of  the  fore-arm.  At  this 
point  was  a  straight  wound,  oblique  like  the  first,  about  eight  inches  in 
length  and  distant  about  two  inches  from  the  fold  of  skin  under  the 
elbow,  to  which  it  was  parallel ;  the  lips  of  this  wound  were  in  contact 
when  weight  was  placed  on  the  limb,  but  gaped  when  the  leg  was  rested. 
No  important  vessels  were  injured. 

The  upper  parts  of  the  limb,  from  the  knee  to  the  withers,  showed 
a  diffuse,  insensitive,  crepitating  swelling,  due  to  subcutaneous  emphy- 
sema. 

Movement  was  slightly  impeded,  but  weight  was  readily  placed  on 
the  limb. 


436  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

The  animal  also  had  a  large  wound  in  the  sheath,  and  a  number  of 
contusions,  none  of  which,  however,  were  of  much  gravity. 

Treatment, — The  parts  were  disinfected,  and  the  lower  angle  of  the 
shoulder  wound  was  laid  open,  to  prevent  discharge  accumulating  in 
the  above-mentioned  cul-de-sac.  Drains  were  inserted  and  warm 
antiseptic  solutions  freely  employed.  An  injection  of  antitetanic  serum 
was  given. 

On  the  following  days  the  wound  suppurated,  but  its  walls  gradually 
became  covered  with  granulations. 

Drainage  was  continued  until  the  20th  April.  At  that  date  the 
wound  near  the  elbow  was  half  healed  and  reduced  to  five  inches  in 
length.  The  shoulder  wound  also  filled  up  rapidly,  though  the  external 
lip  was  strongly  drawn  inwards  in  the  direction  of  the  tract  by  cicatri- 
cial contraction.  To  remedy  this  the  skin  covering  the  outer  surface 
of  the  wound  was  dissected  free  for  a  sufficient  distance  to  allow  of  its 
being  brought  into  contact  with  the  inner  lip,  to  which  it  was  united 
by  a  few  silk  sutures. 

On  the  23rd  April  the  central  part  of  the  tract  had  filled  up.  The 
animal  left  hospital  on  the  i6th  May.  Healing  was  almost  complete. 
There  was  no  lameness,  or  interference  with  movement. 

FOREIGN  BODY  IN  THE  KNEE. 

144.  A  four-year-old  Gordon  setter,  entered  hospital  February  7th, 
1899. 

Had  suffered  since  the  commencement  of  December  from  lameness, 
the  cause  of  which  could  not  be  traced.  One  morning  the  animal  was 
seen  to  be  going  lame  on  the  left  front  leg  and  showed  a  small  circular 
wound  on  the  knee.  It  was  thought  to  have  been  injured  by  a  fragment 
of  glass  from  one  of  the  forcing-houses  of  a  market-gardener,  who  lived 
in  the  neighbourhood.  No  importance  was  attached  to  the  accident. 
In  spite  of  the  use  of  various  topical  applications  and  dressings,  the 
lameness  persisted  and  grew  more  marked,  the  knee  gradually  becoming 
swollen  and  painful.  The  dog  was  finally  brought  to  Alfort  two  months 
after  the  accident. 

State  on  Examination. — The  animal  walked  on  three  legs.  The  left 
fore-limb  was  flexed,  and  no  weight  could  be  borne  on  it.  The  knee, 
the  lower  part  of  the  forearm,  and  upper  part  of  the  metacarpus  were 
swollen,  the  posterior  aspect  of  the  knee  especially  being  greatly 
enlarged.  The  parts  were  so  extremely  sensitive  that  the  animal 
howled  when  they  were  lightly  touched,  or  when  an  attempt  was  made 
to  extend  the  metacarpus  on  the  forearm.  There  was  trifling  traumatic 
fever.     Temperature  38*9°  C. 

After  clipping  the  hair  from  the  swollen  region  a  circular  wound, 
and  two  narrow  sinuous  openings,  from  which  blood-stained  pus  escaped, 
were  discovered,  opposite  the  centre  of  the  knee;  one  was  situated  on 
the  external  surface,  near  the  flexure  of  the  joint  ;  the  other  at  the 
anterior  part  of  the  external  surface. 

These  symptoms  and  the  long-standing  character  of  the  disease, 
led  us  to  suspect  necrosis  of  bone  or  tendon,  or  the  presence   of  a 


SUPPURATING    SYNOVITIS    OF    THE    CARPAL    SHEATH. 


437 


I A    V> 


m'0m 


foreign  body.  In  order  to  settle  the  point  the  patient  was  fastened  to 
the  table,  and  both  sinuses  vertically  exposed.  Exploration  revealed 
no  foreign  body,  or  necrosis.  The  wounds  were  cleansed  with  dilute 
tincture  of  iodine,  and  an  iodoform  cotton-wool  dressing  applied. 
During  the  day  the  temperature  rose  to  39"4°  C.  The  dog  refused 
food,  and  was  therefore  fed  on  milk.  The  dressing  was  renewed  every 
day  until  the  nth. 

On  the  8th  and  gth  the  condition  remained  stationary.    The  animal 
refused  part    of   its   food.      It   always   showed 
acute  pain  on  manipulation  of  the  knee. 

On  the  loth  and  nth  signs  of  improvement 
were  noted.  The  animal  seemed  brighter,  ate 
with  better  appetite,  and  the  knee  was  slightly 
less  sensitive. 

On  the  I2th  the  dog  was  much  brighter, 
left  its  kennel,  and  stood  on  the  injured  limb. 
On  removing  the  dressing,  the  end  of  a  frag- 
ment of  rubber  band  was  seen  in  the  wound 
on  the  external  aspect  of  the  knee  (Fig.  54). 
After  extraction  with  forceps  it  was  found  to 
measure  three  and  a  half  inches  in  length,  one 
twelfth  of  an  inch  in  width,  and  about  one 
thirtieth  of  an  inch  in  thickness. 

The  wounds  were  irrigated  with  carbolic 
solution,  and  a  cotton-wool  dressing  applied. 
During  the  following  days  swelling  and  pain 
rapidly  diminished,  and  the  limb  was  much 
more  freely  used. 

At  the  end  of  a  week  the  wounds  had  healed 
and  the  dog  returned  home,  though  still  slightly 
lame. 

Remark. — This  elastic  band  had  divided  the 
skin,  which  healed  over  it,  and  in  consequence 
of  its  length  and  relaxed  condition  had  re- 
mained for  two  months  in  the  tissues  of  the 
knee  without  producing  grave  lesions.  It  had 
been  divided  when  the  sinuses  were  exposed. 
Although  the  limb  was  very  little  used,  sufficient 
movement  had  occurred  to  displace  the  frag- 
ments, and  cause  one  of  the  ends  to  appear  in  the  wound. 


Fig.  54. 


SUPPURATING    SYNOVITIS    OF    THE    CARPAL    SHEATH. 

145.  A  ten-year-old  gelding,  entered  hospital  December  15th,  i8g6. 

During  August  this  horse  had  fallen  lame  on  the  near  fore-leg.  A 
veterinary  surgeon  who  was  consulted  first  applied  a  blister,  and  a 
month  later  fired  the  knee  in  points.  Two  months  after  the  last 
operation  the  horse  was  returned  to  light  work.  It  worked  for  about 
a  fortnight,  when  the  lameness  returned  and  increased  in  intensity,  the 
knee  meanwhile  becoming  swollen. 


438  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

Three  weeks  before  entering  hospital  an  abscess  had  been  opened 
at  the  upper  part  of  the  knee,  between  the  posterior  and  external 
surfaces ;  after-treatment  had  consisted  in  lotions  and  antiseptic 
injections.  As  the  condition  became  aggravated  the  horse  was  sent  to 
Alfort. 

State  on  Examination. — No  weight  was  placed  on  the  near  fore-liinb. 
When  walking  the  knee  was  not  flexed,  and  the  toe  was  dragged  along 
the  ground.  The  knee  showed  great  swelling,  extending  about  four 
inches  in  an  upward  direction,  and  downwards  as  far  as  the  centre  of 
the  canon-bone.  The  upper  part  of  the  external  surface  exhibited  a 
sinuous  wound  ;  on  the  internal  surface  of  the  limb  the  upper  cul-de- 
sac  of  the  carpal  sheath  was  tense  and  fluctuating.  Pressure  at  this 
point  and  over  the  lower  portion  of  the  sheath  produced  a  considerable 
discharge  of  purulent  synovia. 

The  horse  lay  down  on  the  right  side  almost  as  soon  as  it  entered 
its  box,  and  groaned  frequently.  Temperature  39"o°  C.  It  was  placed 
in  slings.  The  wound  was  disinfected,  and  the  tendon  sheath  irrigated 
with  one  per  thousand  sublimate  solution.  This  treatment  was  con- 
tinued for  three  days. 

On  the  igth  the  horse  was  cast  on  the  right  side.  Over  the  lower 
cul-de-sac  of  the  carpal  sheath  a  counter-opening  was  made  on  the 
external  surface  of  the  limb,  and  a  fragment  of  gauze  introduced  to 
serve  as  a  drainage-tube.  The  upper  cul-de-sac  on  the  inner  surface  of 
the  limb  was  punctured  at  its  most  prominent  part ;  some  purulent 
synovia  escaped.  The  sheath  was  irrigated  with  warm  sublimate 
solution.  Considerable  haemorrhage  followed,  and  was  arrested  by 
plugging.  The  horse  was  replaced  in  slings,  and  the  knee  irrigated 
with  a  small  current  of  water.     The  evening  temperature  was  39*2'^  C. 

Next  day  the  tampon  was  removed,  and  a  second  drain  inserted. 
The  general  condition  was  good,  and  there  was  little  fever. 

From  the  22nd  December  to  the  loth  January  the  temperature 
varied  between  38*5°  and  39*3°  C.  Every  three  or  four  days  the  gauze 
drain  was  renewed. 

On  the  nth  irrigation  was  stopped.  The  animal  still  knuckled 
over  a  little  at  the  fetlock,  but  weight  was  freely  placed  on  the  limb. 
The  second  drainage-tube  was  removed. 

During  the  following  days  the  sheath  was  irrigated  with  one  per 
thousand  sublimate  solution.  Swelling  gradually  diminished,  pus 
became  less  abundant,  and  the  temperature  fell  to  38*0°  C,  where  it 
remained. 

On  the  30th  the  size  of  the  first  drain  was  diminished. 

On  the  loth  February  drainage  was  altogether  suspended,  but  anti- 
septic injections  were  continued  for  some  days  longer. 

The  animal  left  hospital  on  the  i6th  February.  It  was  not  lame  at 
a  walk,  but  still  showed  tenderness  at  a  trot.  This,  however,  disappeared 
soon  after  return  to  work. 

"LUXATION"    OF    THE    PATELLA. 

146.  A  six-year-old  bay  cob  mare,  seen  in  January,  1895. 

History. — The  animal  had  worked  on  the  previous  day,  and  returned 


LUXATION       OF    THE    PATELLA. 


439 


home  perfectly  sound.     Next  morning  it  was  unable  to  walk,  or  even 
to  move  over  m  its  stall. 

State  on  Examinatiun. — The  animal  had  much  difficulty  in  backing 
out  of  its  stall,  and  when  pushed  into  the  yard  stood  in  the  position 
shown  in  Fig.  55. 

The  off  hind  leg  was  extended  and  placed  stiffly  under  the  body, 
with  the  toe  pointing  somewhat  outwards.  The  stifle  and  hock  joints 
were  perfectly  rigid,  and  resisted  all  attempts  at  flexion.  When  the 
mare  was  walked  forwards  the  limb  gradually  became  upright,  rotating 
around  the  toe  as  a  flxed  point,  but  as  it  neared  the  perpendicular  the 
fetlock  was  flexed  more  and  more,  until  finally  it  assumed  the  position 
shown  in  Fig.  56,  the  front  of  the  hoof  then  forming  an  angle  of  about 
15°  to  20°  with  the  ground,  the  metatarsus  and  tibia  being  nearly  vertical, 
the  limb  as  a  whole  inclined  outwards,  and  the  bod}-  leaning  towards 
the  near  side.  This  seemed  the  critical  angle  ;  an}-  further  forward 
movement  was  followed  by  the  leg  escaping,  describing  a  semicircular 
sweep,  and  returning  to  the  position  of  Fig.  55.  There  was  no  par- 
ticular distress  in  moving  forward, 
though  it  was  difficult ;  but  move- 
ment in  a  backward  direction  was 
almost  impossible.  As  the  animal 
could  not  place  the  off  hind  leg 
any  further  behind  it  than  is  shown 
in  the  second  of  the  two  figures, 
movement  in  this  direction  was 
accomplished  by  crouching  down 
nearly  on  to  the  hocks,  rotating 
the  body  on  the  near  hind  leg, 
thus  dragging  back  the  on"  hind, 
then  rising,  taking  weight  on  the 
off  hind,  and  retiring  the  near 
hind.  The  same  process  was  re- 
peated at  each  step. 

The   peculiar   rigidity    of  the 
limb  at  once  suggested  luxation  of 

the  patella,  and  by  thrusting  the  bone  inwards  and  downwards  the 
writer  succeeded  m  reducing  the  condition,  replacement  occurring 
with  a  sudden  click  and  spasmodic  flexion  of  the  limb  similar  to  that 
in  stringhalt.  The  animal  could  then  walk  forwards  in  a  straight  line 
or  move  backwards  without  difficulty,  but  immediately  it  essayed  to 
turn  the  patella  again  became  displaced,  and  had  to  be  assisted  into 
position.  In  all  the  dislocation  was  reduced  five  times  on  the  first 
day.  It  was  difficult  to  distinguish  any  marked  difference  in  the  shape 
of  the  two  stifles,  though  the  displaced  patella  formed  a  somewhat 
more  prominent  mark  on  the  outer  aspect  of  the  stifle,  and  was  rather 
higher  in  position  than  usual. 

The  patient  was  placed  in  slings,  the  leg  drawn  forward  and  fixed 
to  the  girth,  and  the  luxation  finally  reduced. 

The  animal   soon   slipped  out   of   the  slings,  and  when  returned 
hung  with   its  whole  weight  in  them,   so  that  it  had  to  be  released. 


^00. 


Fig.  55. 


44°  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

Next  day  there  was  considerable  local  swelling;  the  patella  was  once 
more  out  of  position,  and  could  not  be  replaced.  Manipulation  gave 
great  pain,  and  at  last  caused  the  animal,  which  had  crouched  down 
on  its  hocks,  to  make  a  sudden  movement  and  fall  over.  Just  at  this 
moment  the  patella  suddenly  slipped  from  under  the  pressure  of  the 
operator's  thumbs,  a  loud  sound  was  heard,  and  the  horse  scrambled 
up,  once  more  able  to  freely  use  the  limb.  It  was  immediately  taken 
back  to  its  stall,  placed  on  a  deep  bed  of  straw,  and  left  to  itself,  the 
only  precaution  taken  being  to  wedge  it  up  on  either  side  with  trusses 
of  straw  so  as  to  prevent  its  lying  down  or  moving  about  much.  Five 
days  later  a  blister  was  applied  round  the  stifle  to  limit  the  movement 
of  the  parts,  and  in  a  month  the  animal  was  returned  to  work.  It 
afterwards  worked  hard  in  a  hansom  cab,  and  appeared  to  have 
suffered  no  ill  effects  from  its  accident. 

Note  by  Mr.  Dollar. — The  peculiar  features  of  this  case  appear  to 
have  been,  firstly  and  principally,  the  position  taken  up  when  at  rest  ; 
secondly,  the  rather  advanced  age  at  which  the  accident  occurred  ;  and 
lastly,  the  rapidity  and  completeness  of  recovery. 

To  sum  up  the  results  of  our  inve-tigation  in  so  far  as  they  tend  to 
answer  the  three  questions  propounded  at  the  commencement  of  this 
article,  I  think  we  may  safely  conclude—  (i)  that  the  patella  in  by  far 
the  greater  number  of  instances  is  not  truly  displaced,  but  only  abnor- 
mally retained  at  a  certain  point  of  its  ordinary  travel.  Where  dis- 
placement does  occur,  however,  it  is  always  outwards,  and  must  be 
accompanied  by  injury  to  the  internal  lateral  ligament. 

(2)  Such  retention  may  be  due  either  to  failure  of  the  nervous 
centres  to  properly  co-ordinate  the  muscular  movements  necessary  to 
release  the  patella  when  at  its  extreme  upper  point  of  travel,  or  to 
spasm  or  paralysis  of  certain  of  the  muscles  involved,  or  merely  to 
mechanical  causes  interfering  with  their  movement  ;  or,  again,  it  may 
result  from  excessive  tension  of  the  inner  straight  ligament,  which 
slips  behind  the  groove  on  the  inner  side  of  the  extremityof  the  femur, 
and  cannot  be  released. 

(3)  That  the  symptoms  are  not  always  the  same,  and  that  they  often 
differ  widely  from  those  of  the  "  classical  "  cases,  as  is  shown  by  that 
described  by  Mr.  Cameron,  and  lastly  by  my  own. 

English  observers  seem  to  concur  in  believing  that  in  luxation  of 
the  patella  the  leg  is  directed  backwards,  that  great  force  is  required 
to  extend  it,  and  that  all  the  joints,  save,  perhaps,  the  fetlock,  are 
fixed ;  and  most  writers  on  the  subject  favour  the  theory  of  relaxation 
or  rupture  of  the  internal  lateral  ligament. 

By  experiments  on  the  dead  subject  M.  Violet  (Lyons  Veterinary 
School)  has  shown  that  the  patella  at  its  highest  point  of  travel 
"  rides  on  the  larger  lip  of  the  trochlea."  The  stifle-joint  cannot  then 
be  flexed  until  it  quits  this  position,  a  movement  which  is  accomplished 
as  follows  : — -"  The  vastus  internus  relaxes  a  little,  whilst  at  the  same 
moment  the  superficial  gluteus  extends  the  femur  slightly  and  draws 
back  the  outer  side  of  the  patella,  causing  it  to  pivot  from  within 
outwards  ;  the  external  straight  ligament  then  becomes  tense  whilst 
the  inner  relaxes,  for  the  central  prominence  of  the  patella  has  now 


"  LUXATION  "    OV    THE    PATELLA. 


441 


glided  into  the  depression  separating  the  two  trochlear  ridges  ;  finally, 
the  internal  ligament  no  longer  opposing  any  resistance,  the  corre- 
sponding side  of  the  patella  rises  and  easily  leaves  the  flattened  surface 
before  described. 

As  soon  as  this  happens  the  flexors  of  the  limb  act,  the  superficial 
gluteus  relaxes,  the  patella  falls  into  its  groove,  and  straightway  com- 
mences its  descent." 

Should,  however,  the  animal  attempt  to  move,  and  the  patella 
refuse  to  leave  its  seat,  the  symptoms  of  luxation  at  once  appear. 

In  replying  to  the  question  of  why  luxation  occurs,  M.  Violet 
regards  the  primary  cause  as  probably  imperfect  muscular  action — 
either  cramp  or  paralysis.  In  other  words,  luxation  is  due  either  to 
(i)  spasmodic  contraction  or  cramp  of  the  inferior  fibres  of  the  vastus 
internus,  which  ma\'  be  sufficient  to  counteract  the  efforts  of  the  super- 
ficial gluteus  ;  or  (2)  paralysis,  feebleness,  or  injury  to  the  superficial 
gluteus,  which  interfere  with,  render  feeble,  or  disorder  its  contraction. 

To  reduce  the  displacement, 
M.  Violet  directs  pressure  to  be 
exercised  backwards  and  in- 
wards, whilst  the  horse  is  thrust 
back  by  an  assistant. 

In  Germany  two  forms  of 
luxation  of  the  patella  have 
been  distinguished — (i)  momen- 
tary luxation,  and  (2)  perma- 
nent luxation.  The  former  is 
attributed  to  abnormal  flatness 
of  the  upper  surface  of  the 
trochlea  before  alluded  to,  or  to  (^,: 
excessive  tension  of  the  lateral 
ligaments  of  the  patella  ;  the 
latter  to  detention  of  the  patella 
on  the  upper  margin  of  the  in- 
ternal trochlear  ridge.  The  symptoms  are  similar  to  those  already 
alluded  to. 

Moller  describes  a  form  of  luxation  whose  symptoms  are  identical 
with  those  in  my  own  case.  He  says,  "  I  have  lately  seen  a  peculiar 
luxation  of  the  patella  upwards  and  outwards.  The  leg  was  extended 
and  directed  forwards,  flexion  was  impossible,  but  weight  could  be 
placed  on  the  limb.  When  moving  the  limb  was  carried  stiffly,  without 
movement  of  the  hip,  stifle,  or  hock-joint,  and  placed  far  forwards  ; 
the  progress  of  the  body  then  brought  the  limb  perpendicularly  below 
the  hip-joint,  but  the  leg  could  not  be  placed  behind  this  point  either 
actively  or  passively.  Slight  pressure  on  the  outer  border  of  the 
patella  sufficed  to  return  it  to  its  position,  upon  which  the  horse  could 
advance  several  steps  in  the  ordinary  way  ;  suddenly,  however,  the 
patella  again  became  displaced,  and  all  the  symptoms  returned. 

"  A  post-mortem  examination  showed  the  inner  lateral  and  the 
inner  and  central  straight  ligaments  to  be  diseased  and  elongated, 
allowing  the  lower  edge  of  the  patella  to  ride  up  over  the  inner  lip  of 


Fig.  56. 


442  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

the  trochlea,  and  become  fixed  in  that  position.  The  upper  border  of 
the  patella  then  inclined  forwards,  and  the  bone  itself  slipped  outwards 
to  the  extent  of  nearly  an  inch  over  the  outer  condyle  of  the  femur. 
When  the  patella  was  replaced,  the  above-named  ligaments  appeared 
relaxed.  The  continued  pressure  of  the  lower  border  of  the  patella  on 
the  femur  had  caused  absorption  of  the  articular  cartilage,  and  the 
formation  in  it  of  a  distinct  depression  which  corresponded  to  the  shape 
of  the  under  surface  of  the  patella. 

"  Efforts  were  made  during  life  to  fix  the  patella  in  position  by 
means  of  a  dressing,  but  had  to  be  given  up  on  account  of  its  causing 
inflammation  and  necrosis.  A  broad  strap  was  therefore  passed  round 
both  stifles  and  fastened  to  the  slings. 

"  A  splint  was  so  applied  to  the  tibia  as  to  exercise  pressure  on  the 
outer  surface  of  the  patella,  but  proved  unsatisfactory,  though  after 
eight  days  of  this  treatment  the  horse  could  stand  and  even  walk  some 
steps  without  assistance.  Previously  it  had  been  unable  to  make  a  single 
step.  The  experiment  was  unfortunately  cut  short  by  the  animal  suc- 
cumbing to  another  disease." 

Mr.  Jno.  A.  W.  Dollar's  case,  Veterinarian,  1895,  p.  248. 

OSSIFICATION    OF    THE    TENDON    OF    THE    SEMI-TENDINOSUS 

MUSCLE. 

147.  A  five-year-old  pony,  which  for  several  months  had  been 
suffering  from  lameness  of  the  off  hind  limb,  entered  hospital  May  5th, 
1893. 

State  on  Examination. — At  rest  the  appearance  of  the  lame  limb  was 
in  no  way  abnormal.  On  examination  the  middle  line  and  inner  sur- 
face of  the  lower  portion  of  the  buttock  showed  a  little  swelling.  A 
bony  slightly  prominent  patch,  which  previously  had  been  overlooked, 
could  be  felt.  When  moving,  not  only  did  the  animal  show  lameness 
but  the  limb  was  abnormally  flexed,  and  at  the  moment  when  this 
spasmodic  contraction  occurred  the  tendon  of  the  semi-tendinosus 
muscle  appeared  unusually  prominent.  When  caused  to  move  backwards 
the  animal  brought  the  foot  violently  to  the  ground,  and  abducted  the 
limb. 

Diagnosis. — -Ossification  of  the  fascia  of  the  thigh,  and,  without 
doubt,  of  the  tendon  of  the  ischio-tibialis.  The  only  hopeful  treat- 
ment consisted  in  removing  the  bony  tumour.  This  operation  was 
suggested  to,  and  accepted  by,  the  owner. 

The  operation  was  performed  with  the  usual  antiseptic  precautions. 
The  bony  patch  penetrated  more  deeply  than  had  been  thought  on 
clinical  examination.  A  drain  was  introduced  to  the  bottom  of  the 
wound,  and  fixed  at  the  surface  by  a  suture.  The  lips  of  the  wound 
were  brought  together  by  interrupted  silk  sutures. 

During  the  following  days  some  sutures  yielded,  and  the  wound 
suppurated.  It  was  not  entirely  healed  until  the  end  of  a  month,  but 
after  the  third  week  the  animal  walked  sound.  On  leaving  hospital  it 
was  again  able  for  work. 

Seen  on  two  subsequent  occasions — the  first  time  eight  months, 


FRACTURE    OF    THE    TIBIA    IN    A    HORSE. 


443 


and  the  second  two  years  after  operation — the  animal  failed  to  show 
the  slightest  irregularity  in  moving  the  limb. 

The  bony  plate  was  triangular,  the  base  being  uppermost  ;  it 
measured  six  inches  in  length  and  three  in  breadth  ;  the  point  was 
embedded  in  the  tendon  of  the  semi-tendinosus  muscle.  The  internal 
surface  was  concave,  especially  at  its  upper  part,  into  which  muscular 
fibres  were  inserted.  The  external 
surface  was  only  separated  from  the 
skin  by  a  layer  of  connective  tissue. 

The  cause  of  ossification  of  this 
character  is  unknown.  The  animal's 
history  did  not  point  to  any  injury 
or  violent  contusion  of  the  buttock. 
Its  age  was  certainly  not  a  predis- 
posing cause,  and  no  abnormal  ossi- 
fication was  detected  in  any  other 
region. 

Note. — M.  Laquerriere  describes 
a  similar  case  as  follows  : — "  In  1874 
I  saw  at  Milianah  a  horse  which  had 
been  lame  for  a  very  long  time,  and 
which  showed  a  subcutaneous  swell- 
ing in  the  upper  external  part  of  the 
right  quarter.  The  horse  was  cast 
and  the  skin  incised,  when  I  found, 
to  my  great  astonishment,  a  plate  of 
apparently  bony  tissue,  measuring 
about  five  inches  in  height,  and  two 
to  two  and  a  half  inches  in  breadth. 
Some  years  before  the  horse  had  been 
wounded  with  a  bullet  in  the  upper 

part  of  the  quarter.  In  consequence  of  its  weight  this  bullet  had 
gradually  descended,  but  in  so  doing  had  produced  inflammation, 
afterwards  followed  b}-  calcification  of  a  portion  of  the  fascia  in  the 
external  crural  region.  Whatever  may  have  been  the  cause,  the 
lameness  disappeared  as  though  by  enchantment  as  soon  as  the  growth 
was  removed." 


Fig.  57. 


-fracture  ot  the  tibia  in 
a  horse. 


FRACTURE    OF    THE    TIBIA    IN    A    HORSE. 


148.  An  aged  bay  cart  mare. 

History. — Whilst  being  shod  the  near  hind  leg  was  lifted,  causing 
the  animal  to  fall  over  against  a  bench  on  its  off  side  ;  it  continued 
leaning  against  the  bench  for  a  few  moments,  but  soon  recovered  itself; 
it  was,  however,  unable  to  place  the  near  hind  foot  to  the  ground.  It 
was  then  led  into  the  yard  walking  on  three  legs,  and  on  the  near  leg 
being  lifted  it  fell  to  the  ground. 

State  on  Examination. — The  animal  seemed  in  great  pain  ;  the  near 
hind  leg  was  slightly  flexed  ;  a  punctured  wound  about  a  quarter  of  an 
inch    in   diameter,  from  which  blood  oozed,  was  noticed  at  the  upper 


444  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

inner  part  of  the  tibia.  The  owner  declared  this  had  been  seen  two 
days  before,  but  that  the  animal  had  not  been  lame.  On  the  day  of 
the  accident  the  patient  had  been  drawing  loads,  one  of  which  weighed 
35  cwt.  It  had  backed  into  a  difficult  place  considering  the  weight 
behind  it.  Careful  questioning  elicited  the  following  facts.  On  the 
day  previous  to  death,  while  drawing  on  the  level,  the  animal  suddenly 
fell,  but  soon  rose  again,  and  seemed  none  the  worse.  The  wound  had 
been  noticed  a  day  previous  to  this.  From  the  position  the  animal 
occupied  in  its  stable  it  could  not  have  been  kicked  by  another  horse. 
After  it  fell  the  upper  part  of  the  leg  around  the  tibia  became  swollen. 

Diagnosis. — Fractured  tibia. 

z\s  there  was  very  little  crepitation,  and  the  bone  was  not  displaced, 
the  animal  vvas  slung.  A  probe  entered  the  wound  for  a  distance  of 
one  and  a  half  inches.  The  animal  hung  in  the  slings  and  could  not 
stand.  Below  the  wound  the  leg  was  insensitive  to  pin-pricks.  After 
full  consideration  the  animal  was  shot. 

Post-mortem  Examination.  —  On  removing  the  skin  from  the  leg  the 
subcutaneous  tissue  for  two  inches  above  and  four  or  live  inches  below 
the  wound  was  seen  to  be  much  bruised  ;  the  wound  extended  into  the 
medullary  cavity  of  the  tibia,  which  contained  a  quantity  of  dark  coa- 
gulated blood  ;  the  bone  was  broken  into  ten  or  twelve  fragments,  and 
cracked  to  within  about  one  inch  of  its  lower  articular  surface. 

Mr.  B.  P.  Godfray's  case,  Veterinarian,  1894,  p   677. 

SUPPURATING  LYMPHANGITIS-ABSCESS  FORMATION  IN  THE  POP- 
LITEAL LYMPHATIC  GLANDS-TREATMENT  BY  OXYGENATED 
WATER     (HYDROXYL). 

149.  A  four-year-old  mare  left  in  hospital  November  12th,  1896. 

Had  been  bought  ten  months  before.  Was  affected  with  verrucous 
dermatitis  (grease)  of  both  hind  legs,  which  had  been  unsuccessfully 
treated  with  warm  solutions  of  lysol. 

On  the  7th  November,  on  returning  from  a  rather  long  journey,  the 
mare  was  seen  to  be  distinctly  lame  on  the  near  hind  leg.  Next  day 
the  leg  was  swollen  as  high  as  the  hock.  During  the  following  days 
swelling  increased,  extending  to  the  lower  part  of  the  thigh.  Lame- 
ness was  intense,  and  the  disease  steadily  became  worse  in  spite  of 
treatment. 

The  animal  was  brought  to  the  school  on  the  evening  of  the  12th 
November.  While  it  was  being  led  into  the  ambulance  an  abscess  in 
the  region  of  the  thigh  broke,  and  discharged  a  considerable  quantity 
of  pus. 

State  on  Entry. — The  entire  limb  was  swollen  and  very  tender  on 
examination.  The  foot  was  rested  on  the  toe.  About  twelve  inches 
above  the  summit  of  the  os  calcis  on  the  posterior  surface  of  the  thigh 
was  a  wound  discharging  viscous,  offensive  pus.  Around  this  wound 
was  a  necrotic  patch  of  skin  measuring  six  inches  by  five.  Removal 
of  the  eschar  exposed  a  large  inflammatory  centre  and  slough  involving 
the  fascia  of  the  thigh,  the  flexor  pedis  perforans,  and  perforatus  muscles, 
the  flexor  muscles  of  the  phalanges,  and  the  popliteus.  A  probe  pene- 
trated about  twelve  inches  and  touched  the  tibia. 


SPAVIN    AND    KNUCKLING    OVER    AT    THE    FETLOCK.  445 

Diagnosis. — Acute  lymphangitis  with  abscess  formation  in  the  popli- 
teal lymphatic  glands,  and  local  moist  gangrene. 

Treatment. — Cleansing  of  the  parts,  excision  of  the  gangrenous 
tissues,  and  disinfection  of  the  wound  with  strong  carbolic  solution. 
Haemorrhage  was  trifling,  but  was  followed  by  discharge  of  lymph.  At 
the  base  of  the  wound  the  posterior  tibial  artery  was  seen.  As  the 
skin  formed  a  pocket  in  the  direction  of  the  hock,  it  was  incised  for  a 
distance  of  three  inches.  The  skin  of  the  fetlock,  pastern,  and  coronet, 
affected  with  grease,  was  clipped,  washed  with  soap  and  water,  and  dis- 
infected with  carbolic  solution,  and  afterwards  treated  with  6  per  cent, 
sulphate  of  copper  solution. 

During  the  first  two  days  the  wound  was  cleansed  night  and 
morning  with  strong  carbolic  solution,  and  dusted  with  tannin.  Frag- 
ments of  dead  tissue  separated,  suppuration  was  very  abundant,  and 
the  odour  extremely  repulsive. 

Swelling  of  the  limb  persisted,  but  the  general  condition  was  good, 
and  fever  moderate.  Temperature  387°  to  3g'3°  C.  The  animal  ate 
the  greater  part  of  its  food. 

On  the  17th  treatment  with  oxygenated  water  (hydroxyl)  was  com- 
menced. Night  and  morning  the  wound  was  cleansed  with  lukewarm 
boiled  water,  and  then  sponged  with  oxygenated  water.  The  tissues 
touched  with  this  fluid  assumed  a  whitish  tint,  which  persisted  for 
about  an  hour.  The  animal  did  not  object  to  the  dressing,  and  did  not 
seem  to  suffer  pain.     Temperature  38*5°  C. 

Next  day  the  wound  was  much  less  foetid,  and  suppuration  had 
markedly  diminished.  The  stream  of  pus  which  previously  ran  down 
the  limb  had  disappeared,  but  a  little  lymph  still  discharged. 

During  the  following  three  days  the  use  of  oxygenated  water  was 
followed  by  similar  effects.  The  w^ound  granulated  actively  over  its 
entire  surface.  Discharge  of  lymph  continued,  but  swelling  gradually 
diminished. 

On  the  25th  the  wound  was  half  healed,  and  the  sinus  communi- 
cating with  its  deepest  part  was  much  smaller. 

On  the  ist  December  the  sinus  had  closed  and  suppuration  ceased. 
The  limb  was  only  slightly  swollen,  and  the  swelling  disappeared  with 
exercise. 

Remark. — In  several  other  cases  of  inflammation  accompanied  by 
gangrene,  and  of  contused  wounds  with  sloughing  margins,  oxygenated 
water  has  had  the  same  remarkable  action.  It  rapidly  purified 
gangrenous  or  septic  areas,  and  diminished  suppuration  and  fever. 


SPAVIN    AND    KNUCKLING    OVER    AT    THE    FETLOCK. 

150.  A  thirteen-year-old  gelding,  left  in  hospital  May  23rd,  1894. 

Had  been  lame  for  about  six  months.  The  lameness,  though  at 
first  intermittent,  became  continuous,  and  for  a  month  previously  had 
rendered  the  animal  useless. 

When  standing  the  off  hind  limb  was  rested  on  the  toe  and  the 
fetlock  markedly  flexed,  in  consequence  of  contraction  of  the  flexor 


446  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

tendons.  A  large  spavin  was  visible,  extending  a  considerable  distance 
forwards.  The  muscles  of  the  croup  and  haunch  were  greatly  wasted, 
in  consequence  of  the  continual  resting  of  the  limb  ;  and  lameness  was 
severe,  even  at  a  walk.     There  was  no  other  apparent  lesion. 

Treatment. — Needle  firing  of  the  bony  tumour,  and  section  of  the 
cunean  tendon  of  the  flexor  metatarsi.  Tenotomy  of  the  perforans 
tendon.  The  knuckling  over  at  the  fetlock  immediately  disappeared. 
The  foot  was  placed  flat  on  the  ground,  but  the  phalanges  seemed 
unsteady  during  movement.  During  the  following  days  the  reaction 
due  to  firing  was  intense.  On  the  29th  the  wound,  consequent  on 
plantar  tenotomy,  had  healed.  The  tendons  were  swollen,  warm,  and 
painful,  and  the  animal  placed  little  weight  on  the  limb.  When 
moving,  the  oscillating  movement  previously  seen  in  the  phalanges 
had  disappeared. 

The  animal  left  hospital  on  the  6th  June,  thirteen  days  after  treat- 
ment. When  returned  a  month  later  it  went  sound  at  a  walk. 
Between  that  date  and  i8g6  it  was  again  seen  several  times.  The 
results  were  good,  and  the  animal  had  continued  walking  work  without 
interruption. 

DISTENSION  OF  TENDON  SHEATHS  IN  FRONT  OF  THE  HOCK. 

151.  A  six-year-old  Anglo-Norman  mare,  affected  with  distension 
of  the  tendon  sheaths  in  front  of  the  right  hock,  entered  hospital 
February  2gth,  1896. 

A  few  months  before  the  antero-external  surface  of  the  right  hock 
was  seen  to  be  swollen.  It  gradually  increased  in  size,  and  was  fired  in 
points  without  success. 

State  oil  Examination. — The  antero-external  surface  of  the  right 
hock  showed  an  elongated  vertical  swelling  extending  above  and 
below  the  hock,  forming  a  semi-cylindrical  enlargement,  slightly  con- 
tracted at  its  centre,  due  to  distension  of  the  sheath  of  the  extensor 
pedis  tendon.  On  manipulation  it  appeared  indolent  and  uniformly 
fluctuating.  If  the  lower  part  were  compressed  the  upper  increased  in 
size,  and  vice  versa.  Fluctuation  existed  throughout.  Manipulation 
showed  that  no  communication  existed  with  the  synovial  membrane  of 
the  joint. 

Treatment. — Puncture  and  drainage  of  the  cavity.  On  the  2nd 
March  the  animal  was  cast  on  the  table,  and  the  anterior  portion  of  the 
hock  prepared  by  shaving  and  disinfecting  the  skin  over  the  ends  of  the 
tumour.  The  lower  part  of  the  swelling  was  compressed  by  an 
assistant,  causing  the  liquid  to  accumulate  in  the  upper  cul-de-sac,  which 
was  then  opened  with  a  bistoury.  A  quantity  of  light  yellow,  slightly 
viscous  liquid,  resembling  synovia,  escaped.  A  grooved  director  passed 
through  the  entire  length  of  the  cavity,  and  was  arrested  b}'  the  wall  of 
the  lower  cul-de-sac,  a  little  below  the  inferior  margin  of  the  hock.  The 
lower  part  of  the  cul-dc-sac  was  opened  over  the  prominence  thus 
produced,  and  the  wound  enlarged  by  passing  a  bistoury  along  the 
groove  of  the  director.  A  rubber  drainage-tube,  rendered  aseptic  by 
boiling  in  carbolic  solution,  was  introduced  into  the  tract. 


MEDIAN    AND    ULNAR    NEURECTOMY.  447 

The  animal  was  returned  to  its  box  and  tied  up.  During  the  night 
the  parts  were  irrigated  with  warm  sublimate  solution.  Temperature 
at  7  p.m.  39"0°  C. 

Next  day  the  parts  were  slightly  swollen  and  painful,  but  injection 
of  antiseptics  did  not  produce  any  marked  struggling. 

During  the  following  days  swelling  and  pain  increased,  and  the  foot 
was  rested  on  the  toe.  Purulent  serosity  escaped  from  the  lower  end 
of  the  drainage-tube.  The  injections  were  continued ;  temperature 
39-2°  to  38-6°  C. 

On  the  6th  the  region  was  less  sensitive,  the  discharge  less  abun- 
dant, and  more  weight  was  placed  on  the  limb.  The  lower  part  of  the 
drainage-tube  was  removed  with  scissors,  and  the  lower  wound  opened 
so  as  to  allow  any  liquid  which  might  accumulate  there  to  escape. 

On  the  loth  the  inilammation,  suppuration,  and  pain  were  much 
diminished.  The  animal  was  suitably  secured,  and  the  drainage-tube 
replaced  by  one  of  smaller  calibre. 

On  the  I2th  suppuration  had  almost  ceased,  and  the  limb  was 
moved  without  difficulty. 

On  the  i8th  drainage  was  discontinued.  The  animal  was  perfectly 
sound  when  walking,  and  at  a  trot  only  showed  occasional  lameness. 

Next  day  it  left  hospital,  returning  to  work  shortly  afterwards.  The 
external  half  of  the  hock  remained  slightly  indurated. 

Remark. — Double  puncture  and  drainage  also  gave  excellent  results 
in  another  draught-horse  similarly  affected.  Distension  of  this  bursa 
offers  the  greatest  clinical  analogy  with  distension  of  the  precarpal 
bursa.      Most  of  the  classic  authors  ignore  it. 

MEDIAN    AND    ULNAR    NEURECTOMY— AFTER-COMPLICATION. 

152.  A  ten-year-old  gelding,  suffering  from  arthritis  of  the  near  fore 
fetlock-joint,  consequent  on  pneumonia.  Treated  at  the  commence- 
ment of  November,  1898,  by  firing  in  points.  After  operation  the 
animal  was  returned  home  ;  the  region  fired  became  covered  with  mud, 
and  was  not  treated  in  any  way. 

At  the  end  of  a  week  three  of  the  punctures  on  the  inner  surface  of 
the  fetlock  discharged  purulent  synovia.  The  parts  became  greatly 
swollen  and  very  hot  ;  the  foot  was  only  rested  on  the  toe.  The 
cauterised  surface  having  been  disinfected  with  a  i  per  1000  warm 
solution  of  sublimate,  and  the  three  small  wounds  touched  with  tinc- 
ture of  iodine,  a  cotton-wool  dressing  was  applied  to  the  fetlock,  and 
kept  moist  by  applications  of  sublimate  solution.  The  dressing  was 
renewed  daily.  Inflammation  remained  confined  to  a  part  of  the 
synovial  membrane.  In  a  fortnight  the  wounds  had  healed,  and  the 
animal  began  to  use  the  diseased  limb.  The  fetlock,  however,  re- 
mained swollen,  and  became  indurated.  The  animal  was  exercised 
night  and  morning  for  ten  minutes  to  a  quarter  of  an  hour,  and  the 
lameness  diminished  to  a  considerable  extent. 

Firing  the  fetlock  in  lines  lessened  the  swelling  and  lameness,  but 
the  animal  always  remained  too  lame  to  trot.  Median  neurectomy 
was  decided  on.     The  result  was  insufficient.     A  month  later  the  ulnar 


448 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


nerve  w^as  divided.     After  operation  the  horse  no  longer  walked  lame, 
and  only  showed  little  lameness  at  a  trot. 

On  the  8th  March,  ten  days  after  division  of  the  ulnar  nerve,  the 
fetlock  of  the  diseased  limb  collapsed.  In  consequence  of  the  want  of 
sensation  in  the  lower  regions  of  the  limb  weight  was  still  placed  on 
it,  but  the  row  of  phalanges  was  horizontal,  and  the  fetlock  touched 
the  ground.  The  heels  of  the  foot  were  horizontal,  and  the  toe  pro- 
jected upwards.  The  canon-bone  formed  an  angle  of  nearly  ninety 
degrees  with  the  phalanges.      The  fetlock  was   wider   than    normal, 


Fig   58. — Rupture  of  the  flexor  tendons,  etc.,  after  neurectomy. 


though  it  was  impossible  to  exactly  discover  the  position  of  the  lesions. 
Rupture  of  the  flexor  tendons  and  suspensory  ligaments  was  diagnosed. 
As  the  skin  covering  the  posterior  surface  of  the  joint  and  the  synovial 
membrane  of  the  joint  itself  had  become  lacerated  in  consequence  of 
movement  and  repeated  rubbing,  the  animal  was  slaughtered. 

Examination  of  the  Lesions. — Incision  through  the  skin  exposed  a 
thick  layer  of  infiltrated  fibrous  tissue  enveloping  the  tendons,  the 
upper  parts  of  which,  however,  were  intact.  Opposite  the  fetlock  the 
tendons  were  displaced  towards  the  right  and  inflamed  for  a  distance 


guiTTOR.  449 

of  three  to  four  inches.  The  perforatus  tendon  had  become  elongated. 
Its  fibres  were  partially  ruptured,  necrotic,  and  disintegrated ;  the 
perforans  tendon  showed  similar  changes.  Only  the  terminal  branches 
of  the  suspensory  ligament  showed  change  ;  they  were  swollen,  in- 
flamed, infiltrated  with  serosity  and  blood,  a  condition  which  became 
more  marked  towards  their  extremities.  The  insertion  itself  was 
destroyed,  the  fibres  being  softened  and  degenerated.  The  surfaces  of 
attachment  on  the  sesamoid  bones  were  rough  to  the  touch.  The 
intersesamoid  ligaments  were  ruptured,  and  the  sesamoid  bones  thrust 
to  either  side  of  the  upper  extremity  of  the  first  phalanx,  causing  the 
enlargement  of  the  fetlock  above  mentioned.  The  inferior  sesamoid 
ligaments  had  only  undergone  trifling  change.  The  metacarpo-phalan- 
geal  synovial  membrane  was  inflamed,  and  at  points  was  stained  with 
blood.  The  articular  surfaces  were  free  of  injury.  The  great  sesa- 
moid sheath  and  the  bones  showed  no  change. 

QUITTOR— PARTIAL    NECROSIS    OF    THE    ANTERIOR    LATERAL 
LIGAMENT    OF    THE    PEDAL    JOINT. 

153.  A  ten-year-old  gelding  with  quittor,  entered  hospital  October 
13th,  1897. 

The  disease  had  been  in  existence  for  six  weeks.  During  the 
previous  three  days  the  animal  was  unable  to  work. 

State  on  Examination. — The  inner  surface  of  the  off  fore  coronet 
showed  a  diffuse,  slightly  sensitive  swelling,  at  the  posterior  part  of 
which  were  two  small  cicatrices  :  and  in  front,  opposite  the  anterior 
portion  of  the  lateral  cartilage,  a  sinus  about  an  inch  and  a  half  in 
depth,  discharging  an  abundance  of  watery  pus.  The  wall  of  the  hoof 
was  separated  along  almost  the  whole  of  the  internal  quarter.  At  rest 
the  limb  was  extended,  and  continually  lifted  and  set  down  with  a 
tapping  movement.     Even  at  a  walk  lameness  was  very  marked. 

Treatment. — The  shoe  was  removed,  the  horn  pared  away,  and  the 
foot  enveloped  in  moist  compresses.     Temperature  38'g°  C. 

On  the  14th  the  animal  was  cast,  the  foot  prepared,  the  horn  of  the 
quarter  removed,  and  the  classic  operation  for  quittor  performed.  All 
the  anterior  portion  of  the  lateral  cartilage  was  necrotic  ;  the  fibrous 
layer  below  was  almost  entirely  granulating.  The  anterior  lateral 
ligament  of  the  joint  was  partially  necrosed  ;  the  superficial  layer  was 
yellowish  in  colour,  and  appeared  softened  and  broken  down. 

The  remainder  of  the  cartilage  was  removed,  together  with  the 
necrotic  layer  of  the  ligament,  and  the  wound  swabbed  with  tincture  of 
iodine.  The  parts  having  been  scrupulously  cleansed,  the  deeper 
tissues  were  covered  with  a  thick  layer  of  iodoform,  and  the  foot 
dressed  with  gauze  and  cotton  wool. 

On  rising  the  horse  appeared  distinctly  easier  than  before  operation, 
and  when  returned  to  its  box  ate  with  some  appetite.  In  the  afternoon, 
however,  it  lay  down.  Respiration  became  rapid  and  moaning,  and 
frequent  lancinating  pain  was  shown.  In  the  evening  the  animal  ate 
some  oats  and  part  of  its  hay.  Temperature  40'^  C,  respirations  26, 
pulse  58. 

F  F 


45°  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

During  the  following  days  the  general  condition  improved,  though 
considerable  pain  still  persisted.  The  temperature  varied  between 
38-5°  and  397°  C. 

On  the  19th  the  horse  began  to  place  weight  on  the  limb.  Tempera- 
ture 38-2°  to  38-4''  C. 

From  the  20th  to  the  23rd  improvement  increased.  More  weight 
was  placed  on  the  diseased  limb. 

On  the  24th  the  dressing  was  renewed.  There  was  little  pus.  The 
wound  appeared  healthy  and  granulating  throughout,  both  opposite  the 
ligament  and  at  the  back.  It  was  thoroughly  cleansed,  a  shoe  applied, 
and  the  parts  dressed  with  iodoform.  In  consequence  of  the  concussion 
produced  during  shoeing,  and  the  much  greater  compression  caused  by 
the  new  dressing,  less  weight  was  placed  on  the  limb.  Lameness  was 
more  marked,  and  lancinating  pain  returned  to  a  slight  degree.  From 
the  25th  to  the  2gth  the  condition  gradually  improved.  On  the  30th 
as  much  weight  was  placed  on  the  diseased  as  on  the  healthy  limb. 

On  the  5th  November  the  dressing  was  renewed.  There  was  little 
pus.  The  wound  had  almost  completely  healed,  and  the  horse  showed 
no  lameness  at  a  walk. 

154.  A  ten-year-old  mare  with  quittor  of  the  near  fore-foot,  left  in 
hospital  August  5th,  1898. 

Two  months  before  the  coronet  of  the  near  fore-foot  had  been 
injured.  The  wound  was  complicated  by  necrosis  of  the  internal 
lateral  cartilage.  Treatment  by  caustic  injections  and  cauterisation 
was  unsuccessful,  and  partial  operation  also  failed. 

State  on  Entry. — At  rest  no  weight  was  placed  on  the  near  fore-limb, 
which  was  advanced  and  rested  on  the  toe.  At  a  walk  the  animal  was 
very  lame.  Over  the  internal  lateral  cartilage  the  coronet,  which 
showed  signs  of  having  been  tired  in  points,  exhibited  a  considerable 
swelling,  especially  towards  the  heel.  Above  the  centre  of  the  lateral 
cartilage  was  a  sinus  about  an  inch  in  depth,  running  obliquely  for- 
wards and  downwards,  and  discharging  liquid,  greenish,  abundant  pus. 

Treatment. — The  shoe  was  removed,  the  inner  heel,  bar,  sole,  and 
frog  of  the  injured  foot  thinned,  the  hair  clipped  away  from  the  coronet 
and  pastern,  and  a  large  antiseptic  moist  dressing  applied.  Next  day 
the  mare  was  cast  on  the  left  side  on  the  table,  and  the  limb  suitabl}' 
fixed. 

The  foot,  coronet,  and  pastern  having  been  disinfected,  operation 
was  proceeded  with.  The  sinus  ended  over  the  anterior  lateral 
ligament.  After  having  removed  the  remaining  portion  of  the  cartilage 
the  surface  of  the  ligament  appeared  in  a  necrotic  condition,  dull, 
softened,  and  yellowish  grey  in  colour,  its  fibres  swollen  and  separated. 
The  dead  portions  were  removed  with  a  sharp  knife.  The  remaining 
part  of  the  ligament  was  several  times  touched  with  tincture  of  iodine. 
The  operation  wound  having  been  irrigated  with  warm  i  per  1000 
sublimate  solution,  an  iodoform  dressing  was  applied.  The  evening 
temperature  was  38 "5°  C. 

Next  day  the  general  condition  was  good.  The  animal  showed  a 
little  lancinating  pain  in  the  diseased  limb  ;  temperature  39*0°  C. 


OPERATION    FOR    PICKED-UP    NAIL.  45 1 

On  the  8th  the  temperature  was  38*3°  C.  Occasional  lancinating 
pain  was  still  noted. 

On  the  gth  pain  had  ceased ;  the  temperature  and  principal 
functions  were  normal.  On  the  following  days  the  animal  began  to 
place  weight  on  the  foot. 

On  the  14th  the  dressing  was  removed ;  the  wound  was  granulating 
throughout,  and  visibly  disposed  to  heal.  A  shoe  and  dressing  were 
applied.  Weight  was  readily  placed  on  the  limb,  and  lameness  was 
trifling. 

On  the  25th  the  dressing  was  again  renewed.  Healing  was  almost 
complete,  and  lameness  scarcely  noticeable  at  a  walk. 

OPERATION    FOR    PICKED-UP    NAIL. 

155.  A  ten-year-old  gelding  suffering  from  picked-up  nail  in  the 
middle  zone  of  the  near  hind  foot.  Treatment  by  thinning  the  horn 
and  poulticing  had  only  resulted  in  the  condition  becoming  aggravated. 
The  horse  was  sent  to  hospital  on  the  14th  April,  1896. 

No  weight  was  placed  on  the  diseased  limb,  the  animal  walking  on 
three  legs.  The  injur}-  in  the  sole  traversed  the  anterior  part  of  the 
external  branch  of  the  frog,  which  was  very  prominent  at  this  point 
in  consequence  of  swelling  of  the  subjacent  tissues.  The  sinuous 
wound  discharged  a  large  amount  of  yellowish  viscous  pus.  The 
flexure  of  the  pastern  was  swollen  ;  temperature  3g'o^  C. 

Treatment. — Thinning  of  the  sole  and  frog  ;  immersion  of  the  foot 
in  warm  carbolic  solution  for  twenty  minutes  ;  application  of  peat 
wool  compresses  soaked  in  the  same  solution. 

Next  day  the  animal  lay  continually.  The  affected  limb  was  moved 
spasmodically  in  consequence  of  darting  pain. 

The  horse  having  been  cast,  and  the  limb  fi.xed  in  a  convenient 
position,  the  partial  operation  for  picked-up  nail  was  performed.  A 
portion  of  the  plantar  cushion  was  removed  ;  the  sinuous  tract  laid 
open  in  front  and  behind,  and  an  elliptical  piece  removed  from  the 
margins  of  the  plantar  aponeurosis,  so  as  to  produce  a  button-shaped 
aperture  three  eighths  of  an  inch  in  length. 

The  small  sesamoid  sheath,  being  full  of  purulent  synovia,  was 
irrigated  with  warm  2  per  cent,  lysol  solution,  powdered  with  calomel, 
and  enveloped  in  a  cotton-wool  dressing. 

Next  day  the  animal  showed  evidence  of  acute  pain.  It  only  rose 
to  eat,  and  even  then  left  a  portion  of  its  food.  Temperature  38'6°  C. 
Less  signs  of  lancinating  pain. 

During  the  following  days  the  condition  remained  stationary ; 
temperature  387°  to  395°  C. 

On  the  22nd  the  dressing  was  renewed.  The  operation  wound 
had  commenced  to  granulate  ;  there  was  little  pus  ;  the  parts  were 
irrigated  with  lysol  solution,  and  dressed  with  calomel. 

From  the  23rd  to  the  30th  the  animal  remained  lying  for  the 
greater  portion  of  the  time  ;  temperature  38"5°  to  39*3°  C. 

On  the  ist  May  the  dressing  was  changed.  The  flexure  of  the 
pastern  was  swollen   in  consequence  of  an  abscess  having  developed. 


452  CLINICAL    VKTERINARY    MEDICINE    AND    SURGERY. 

This  was  punctured,  and  the  cavity  washed  out  ;  the  foot  was  then 
immersed  in  lysol  sohition,  and  again  dressed  with  cotton  wool. 

During  the  following  days  the  condition  improved  ;  the  tempera- 
ture fell  to  38'o°  C.  and  more  weight  was  placed  on  the  foot. 

On  the  1 2th  the  dressing  was  removed  ;  the  operation  wound  was 
healing  well,  as  was  that  produced  by  opening  the  abscess.  On  the 
i6th  the  abscess  wound  had  closed. 

The  animal  left  hospital  on  the  igth.  Lameness  was  still  marked, 
but  the  horse  walked  well  enough  to  return  to  its  own  stable. 

156.  A  seven-year-old  entire  horse,  left  in  hospital  25th  September, 
1897.  Suffering  from  picked-up  nail  in  the  middle  zone  of  the  foot. 
Operation  had  been  unsuccessfully  performed. 

State  on  Examination. — The  off  hind  leg  was  the  seat  of  frequent 
darting  pain  ;  in  the  intervals  the  foot  was  rested  on  the  toe.  Lame- 
ness was  very  severe,  the  toe  being  dragged  along  the  ground.  The 
parts,  moreover,  were  very  hot  and  sensitive.  The  operation  wound 
was  surrounded  by  fungous  granulations,  which  masked  a  sinus  dis- 
charging coagulated,  foetid  pus.  The  navicular  bone  was  not  exposed 
at  any  point,  previous  operation  having  been  confined  to  the  plantar 
cushion  and  the  superficial  layer  of  the  aponeurosis.  Despite  these 
grave  local  and  functional  symptoms  the  general  state  was  fairly  good, 
and  the  appetite  preserved.     Temperature  38"4'^  C. 

Treatment. — The  foot  was  pared,  disinfected,  and  surrounded  with  a 
peat  wool  dressing,  continually  moistened  with  carbolic  solution. 

On  the  26th,  the  animal  having  been  cast  on  the  table,  the  com- 
plete operation  for  picked-up  nail  was  performed.  The  lower  surface 
of  the  navicular  bone  appeared  roughened,  and  was  already  granu- 
lating at  points.  Part  of  the  right  half  of  the  perforans  tendon 
showed  necrosis,  which  extended  a  considerable  distance  upwards. 
In  excising  this,  one  of  the  synovial  sheaths  in  the  flexure  of  the 
pastern,  without  doubt  the  cul-de-sac  of  the  great  sesamoid  sheath,  was 
accidentally  opened.     A  jet  of  synovia  escaped  from  the  wound. 

A  counter-opening  was  made  in  the  flexure  of  the  coronet,  and  a 
gauze  drain  passed  ;  after  carefully  cleansing  the  wound,  the  fragment 
of  necrotic  tissue  left  on  the  tendon  was  touched  with  tincture  of 
iodine.     The  parts  were  enveloped  in  an  iodoform  dressing. 

On  returning  to  the  stable  the  horse  began  to  eat.  During  the 
night  the  general  disturbance  was  very  trifling. 

During  the  following  days  the  chief  functions  were  normal  ;  the 
temperature  did  not  rise  beyond  3g'3°  C.  For  a  week  the  foot  was 
rested  on  the  toe,  and  signs  of  severe  stabbing  pain  were  evident. 

On  the  2nd  October  the  dressing  was  renewed.  The  base  of  the 
wound  was  granulating,  and  the  wound  in  the  synovial  membrane  had 
healed. 

From  the  5th  pain  diminished,  more  weight  was  placed  on  the 
limb,  and  the  foot  was  at  times  rested  flat  on  the  ground. 

On  the  9th  the  dressing  was  removed.  A  considerable  quantity  of 
pus  was  found  in  the  wound,  which,  however,  was  granulating  through- 
out, except  where  the  drain  had  been  passed.     It  was  washed  out  with 


OPERATION    FOR    PICKED-UP    NAIL.  453 

carbolic  solution,  and  a  fresh  gauze  drain  inserted.  Next  day  less 
weight  was  placed  on  the  foot,  but  no  general  disturbance  was  noted. 

From  the  12th  improvement  was  rapid.  The  dressing  was  renewed 
every  week,  the  thickness  of  the  gauze  drain  being  diminished. 

On  the  28th  drainage  was  suspended,  a  shoe  was  applied,  and  a 
dressing  kept  in  position  by  splints  inserted.  The  horse  showed  little 
lameness  when  walking. 

Left  hospital  on  the  7th  November,  and  returned  to  light  work  a 
few  days  later. 

157.  A  five-year-old  entire  horse,  suffering  from  picked-up  nail  in 
the  left  hind  foot,  entered  hospital  March  5th,  1898.  Three  weeks 
before  an  operation  had  been  performed  by  a  veterinar}-  surgeon ;  the 
wound  had  become  sinuous. 

Condition  on  Entry. — Lameness  was  very  marked,  the  foot  resting 
on  the  toe.  There  was  frequent  stabbing  pain ;  the  limb  was  swollen 
as  high  as  the  hock,  and  the  coronet  enlarged,  especially  at  the  back, 
and  in  the  flexure  of  the  pastern. 

The  dressing  covering  the  lower  surface  of  the  foot  was  removed.  The 
woundoccupiedthemiddlezoneof  the  external  lateral  lacuna;  its  margins 
were  greatly  swollen  and  vegetating,  and  discharged  purulent  synovia. 

Treatment. — Disinfection  of  the  foot  and  wound ;  carbolic  baths  ; 
application  of  a  moist  dressing.  Next  morning  the  horse  was  found 
sitting  up  like  a  dog,  with  the  hind  limbs  extended  under  the  body.  It 
was  assisted  to  rise. 

After  casting  the  animal  on  the  table  the  complete  operation  for 
picked-up  nail  was  performed.  The  external  half  of  the  plantar  apo- 
neurosis {i.  e.  the  expanded  terminal  portion  of  the  flexor  pedis  per- 
forans  tendon)  was  necrotic  to  a  point  level  with  the  posterior  margin 
of  the  navicular  bone,  which  had  been  penetrated  close  to  its  anterior 
border.  At  that  point  was  a  splinter  of  bone,  which  was  removed 
with  forceps.  The  navicular  joint  had  been  opened,  the  interosseous 
ligament  detached  from  the  navicular  bone,  and  the  inferior  synovial 
ad-de-sac  perforated.  After  touching  th©  articular  wound  with  tinc- 
ture of  iodine  the  parts  were  irrigated  with  warm  2  per  cent,  carbolic 
solution,  covered  with  iodoform,  and  plugged  with  gauze.  The  foot 
was  surrounded  with  a  cotton-wool  dressing. 

During  the  next  two  days  pain  was  acute.  Temperature  39"o°  to 
39-6°  C. 

On  the  9th  the  dressing  was  removed,  the  wound  cleansed  with  an 
antiseptic  solution  and  covered  with  a  fresh  iodoform  dressing. 

From  the  loth  to  the  17th  the  general  condition  remained  good. 
The  fall  in  temperature,  diminution  in  frequency  of  stabbing  pain, 
lessened  swelling,  return  of  appetite,  and  ability  to  stand,  all  showed 
that  the  wound  was  healing  without  complication. 

On  the  i8th  the  dressing  was  renewed.  The  coronet  was  slightly 
swollen,  the  parts  were  granulating  throughout.  The  articular  wound 
had  healed. 

On  the  ist  April  a  shoe  and  splint  dressing  were  applied.  A  week 
later  exercise  was  commenced.  ' 


454  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

On  leaving  hospital  on  the  20th  April  the  horse  was  able  to  resume 
work. 

158.  iVn  eleven-year-old  entire  horse,  left  in  hospital  7th  November, 
1898. 

Five  weeks  before  had  picked  up  a  nail  in  the  near  fore-foot.  The 
wound  was  unsuccessfully  treated  by  caustics  and  antiseptics.  On  the 
4th  November  signs  of  complication  appeared,  the  injured  foot  being 
carried  clear  of  the  ground.  The  veterinary  surgeon  in  charge  recom- 
mended sending  the  animal  to  Alfort. 

State  0)1  Entry. — The  animal  had  great  difficulty  in  descending  from 
the  ambulance,  and  force  was  required  to  make  it  walk  to  its  box.  No 
weight  whatever  could  be  placed  on  the  near  fore-foot.  The  general 
condition  was  bad,  and  the  face  showed  signs  of  suffering. 

On  removing  the  dressing  a  large  fungating  sinuous  wound,  covered 
with  yellowish-white  discharge,  was  seen  towards  the  middle  of  the 
external  lateral  lacuna. 

Tr&atment. — Thinning  of  the  frog  and  sole,  and  moist  applications 
to  the  foot. 

Next  day,  although  the  temperature  was  only  38*6°  C,  operation 
was  considered  necessary.  The  horse  was  cast  on  the  right  side  on 
the  table.  The  near  fore-foot  was  carefully  fixed,  the  sole  stripped, 
and  the  operation  for  picked-up  nail  performed.  The  plantar  cushion 
was  divided  at  right  angles  to  the  surface  of  the  sole,  about  three 
eighths  of  an  inch  behind  the  point  of  the  frog.  The  insertion  of  the 
perforans  tendon  was  spared  as  much  as  possible.  It  was  lifted  with  a 
retractor  to  allow  the  lower  surface  of  the  navicular  bone  to  be  scraped. 
Its  surface  of  insertion  on  the  pedal  bone  was  preserved  in  its  entirety. 
The  interosseous  ligament  had  been  injured  by  the  nail,  opposite  the 
anterior  margin  of  the  navicular  bone,  and  at  this  point  was  several 
times  touched  with  tincture  of  iodine.  The  wound  was  washed  out 
with  warm  salt  solution,  and  with  i  in  1000  sublimate  solution  ;  then, 
using  a  director,  enveloped  in  wadding  saturated  with  tincture  of 
iodine,  the  superior  cul-de-sac  of  the  small  sesamoid  sheath  was  care- 
fully disinfected. 

A  traumatol  dressing  was  applied,  the  parts  plugged  with  gauze 
and  surrounded  with  a  cotton-wool  dressing.  After  operation  the 
temperature  was  39"5°  C,  in  the  evening  38*6°  C.  During  the  night 
the  horse  ate  its  food. 

Next  morning  the  general  condition  was  good.  Temperature 
38-4°  C,  evening  38-6°  C. 

From  the  loth  to  the  17th  November  the  temperature  varied  be- 
tween 38*0°  and  38*8°  C.  There  was  little  stabbing  pain.  The  appe- 
tite was  preserved,  and  everything  showed  that  healing  was  occurring 
regularly. 

On  the  1 8th  the  dressing  was  removed.  A  quantity  of  blood- 
stained discharge  was  found  under  the  gauze.  Except  on  the  navicular 
bone  the  wound  was  granulating  throughout.  It  was  cleansed,  irrigated 
with  warm  sublimate  solution  powdered  with  traumatol,  and  covered 
with  a  new   cotton-wool    dressing.     During    the   following   days   the 


COMPLICATED    CASES    OF    CORN.  455 

temperature  only  exceeded  normal  by  a  few  tenths  of  a  degree.     From 
the  24th  some  weight  was  placed  on  the  injured  limb. 

On  the  ist  December  the  wound  was  half  healed.  A  shoe  and 
dressing  were  applied.  The  horse  walked  easily;  at  a  walk  there  was 
only  trifling  lameness.      It  left  hospital  on  the  8th  December. 

COMPLICATED    CASES    OF    CORN. 

159.  A  twelve-year-old  mare,  left  in  hospital  November  2nd,  1897. 
Had  been  lame  on  the  off  fore-limb  for  nearly  three  months.  Corns 
had  been  found  in  the  feet,  and  treated  by  thinning  the  horn.  Lame- 
ness, at  lirst  trifling  and  intermittent,  had  become  intense  during  the 
previous  week. 

When  examined  the  mare  was  too  lame  for  work.  At  rest  the  off 
fore-limb  was  advanced.  Lameness  was  severe  even  when  walking. 
The  foot  was  very  sensitive,  and  a  suppurating  corn  could  be  seen  in 
the  internal  quarter.  The  heel  and  posterior  half  of  the  quarter  were 
swollen. 

Treatment. — Thinning  of  the  sole,  bar,  and  frog  ;  exposure  of  the 
fistula ;  clipping  away  of  the  hair  of  the  coronet  and  pastern  ;  careful 
washing  of  these  parts,  and  of  the  foot  with  soap  and  water ;  carbolic 
baths ;  and  moist  antiseptic  application  to  the  foot. 

On  the  2nd  and  3rd  November  the  dressing  was  saturated  with 
carbolic  solution.     No  improvement. 

On  the  4th  the  mare  was  cast  for  operation.  The  heel  of  the  hoof 
was  entirely  removed  for  a  distance  of  about  two  inches;  the  wall 
thinned  together  with  the  corresponding  portion  of  the  sole,  and  part 
of  the  frog.  A  patch  of  necrotic  lamina;  was  removed  with  the  knife. 
A  sinuous  tract,  running  obliquely  upwards  and  inwards,  opened  in  the 
commissure,  between  the  quarter  and  the  reflection  of  the  bar,  pene- 
trating a  long  distance  into  the  plantar  cushion.  After  laying  open  the 
fistula,  parallel  to  the  axis  of  the  foot,  and  excising  an  elliptical  portion 
of  the  plantar  cushion,  a  mass  of  necrotic  tissue,  the  size  of  a  small  nut, 
was  discovered,  formed  by  the  base  of  the  cartilage  and  the  plantar 
cushion. 

The  necrotic  tissues  were  freely  removed  with  the  knife  and 
curette  ;  the  base  of  the  wound  was  swabbed  with  tincture  of  iodine, 
irrigated  with  iodine  lotion  and  covered  with  iodoform,  iodoform  gauze, 
and  a  cotton-wool  dressing. 

On  rising  the  animal  placed  more  weight  on  the  diseased  limb  than 
before  operation.     Evening  temperature  38*6°  C. 

On  the  5th  weight  was  placed  on  the  limb,  and  there  was  no 
evidence  of  stabbing  pain.  During  the  following  days  improvement 
continued.     The  temperature  was  normal. 

On  the  13th  the  dressing  was  removed.  The  wound  was  healing 
well ;  the  loss  of  tissue  in  the  region  of  the  laminae  had  been  repaired, 
and  the  wound  was  covered  with  horn.  The  cavity  on  the  plantar 
surface  was  granulating  throughout.  There  was  little  pus.  A  fresh 
cotton-wool  dressing  was  applied. 

On  the  20th  a  shoe  was  applied  and  a  dressing  inserted,  kept  in 


45^  CLINICAL,    VETERINARY    IMEDICINE    AND    SURGERY. 

position  by  splints.  When  resting  the  foot  was  no  longer  advanced, 
and  at  a  walk  the  animal  appeared  sound.  Left  hospital  November 
24th. 

160.  A  seven-year-old  mare,  left  in  hospital  November  28th,  1897, 
suffering  from  suppurating  corn  in  the  inner  heel  of  the  off  fore-foot. 
Had  been  unsuccessfully  treated  by  caustic  injections.  When  standing 
the  injured  foot  was  rested  on  the  toe.  At  a  walk  lameness  was  severe. 
The  inner  heel  had  been  thinned,  and  was  very  sensitive.  At  the  point 
of  reliection  of  the  bar  a  sinus  had  opened,  and  discharged  considerable 
quantities  of  watery  pus.  The  inner  half  of  the  coronet  was  swollen 
and  painful. 

Treatment. — Disinfection  of  the  foot ;  thinning  of  the  sole  and  bar  ; 
antiseptic  baths  ;  moist  dressing. 

Next  day  the  patient  was  cast,  and  the  right  fore-limb  tixed  to  the 
corresponding  hind.  The  sinus,  an  inch  in  depth,  was  washed  and  laid 
open.  A  double  elliptical-shaped  incision  revealed  a  large  mass  of 
necrotic  tissue,  formed  bv  part  of  the  plantar  cushion  and  of  the  lateral 
cartilage,  extending  to  the  retrorsal  process.  This  was  removed  with 
the  knife,  and  the  base  of  the  wound,  that  is  the  base  of  the  cartilage 
and  of  the  retrosal  process  curetted.  The  wound  was  irrigated  with 
sublimate  solution,  dusted  with  iodoform,  plugged  with  gauze,  and 
covered  with  a  cotton-wool  dressing.  In  the  evening  there  was  some 
darting  pain  ;  temperature  387°  C. 

Next  day  the  foot  was  rested  on  the  toe.  There  was  still  a  little 
darting  pain;  temperature  38-5°  C.  During  the  next  three  days  more 
weight  was  placed  on  the  foot. 

On  the  4th  December  the  wound  was  examined.  It  contained  very 
little  pus.  After  cleansing,  a  dry  point  was  detected  near  the  bottom 
and  was  touched  with  tincture  of  iodine.  A  calomel  dressing  was 
used. 

On  the  nth  the  dressing  was  removed.  The  wound  showed  a  little 
discharge,  but  was  granulating  throughout.  Pressure  on  the  coronet 
still  produced  pain.     A  bar  shoe  and  tow  dressing  were  applied. 

On  the  17th  the  animal  no  longer  walked  lame.  Left  hospital  on 
the  23rd. 

161.  A  fourteen-year-old  entire  horse,  left  in  hospital  May  igth, 
i8g8,  suffering  from  suppurating  corn  in  the  inner  heel  of  the  off  fore- 
foot. Had  been  operated  on  three  weeks  before.  The  operative 
wound  had  become  sinuous.  Lameness  was  intense,  and  the  animal 
had  to  be  carted  to  Alfort. 

The  off  fore-foot  was  rested  on  the  toe,  and  continually  lifted- 
in  consequence  of  lancinating  pain.  The  coronet  was  swollen  and 
painful  over  the  inner  heel  and  posterior  portion  of  the  quarter.  The 
sinus  and  the  plantar  surface  discharged  greyish  blood-streaked  pus. 

Treatment. — The  inner  heel  was  thinned  ;  the  foot  disinfected  and 
enveloped  in  large  compresses  of  peat  wool  saturated  with  3  per  cent, 
carbolic  solution. 

Operation  was  performed  on  the  21st      The  animal  was  cast  on  the 


GRANULOMA    ON    FOOT    OF    STALLION.  457 

right  side,  and  the  diseased  Hmb  fixed  to  the  corresponding  hind  Hmb. 
The  internal  branch  of  the  sole  and  the  wall  of  the  heel  being  loose 
were  completely  removed.  The  sinus  was  cleansed  and  laid  open  in 
front ;  from  either  side  of  the  incision  a  slip  of  the  velvety  tissue  and 
of  the  plantar  cushion  was  removed.  A  necrotic  fragment  was  then 
seen,  formed  by  a  portion  of  the  plantar  cushion  and  the  lateral 
cartilage.  This  fragment  was  removed  with  the  knife,  and  the  base  of 
the  wound  curetted.  After  cleansing  with  sublimate  solution  the 
margins  of  the  wound  were  touched  with  tincture  of  iodine,  covered 
with  a  layer  of  europhene,  plugged  with  gauze,  and  enveloped  in  a 
cotton-wool  dressing. 

On  the  following  days  there  was  no  stabbing  pain.  The  tempera- 
ture did  not  exceed  38*7°  C.  At  first  weight  was  sparingly  placed  on 
the  foot,  but  the  tread  afterwards  became  more  and  more  firm. 

On  the  28th  the  horse  scarcely  showed  lameness  at  a  walk.  The 
dressing  was  renewed,  the  wound  being  found  to  contain  little  pus  and 
to  be  healing  well.  The  parts  were  dressed  a  second  time  with  euro- 
phene. At  the  end  of  a  few  days  weight  was  firmly  placed  on  the 
foot,  and  the  temperature  was  normal. 

On  the  4th  June  the  wound  was  covered  with  granulations  ;  swell- 
ing of  the  coronet  had  ahnost  entirely  disappeared.  A  bar  shoe  and 
tow  dressing  were  applied. 

The  animal  left  hospital  on  the  nth  June,  at  which  time  it  no 
longer  appeared  lame  at  a  walk. 

Remark. — Before  the  introduction  of  antisepsis,  operation  for  com- 
plicated corns  was  often  followed  by  a  return  of  necrosis  in  the  lateral 
cartilage  or  in  the  plantar  cushion,  and  sometimes  by  their  extension 
to  the  plantar  aponeurosis.  In  both  cases  it  finally  became  necessary 
to  excise  tissues  very  freel}'.  At  the  present  time  free  removal  of  the 
necrotic  tissue,  careful  curettage  of  the  base  of  the  wound,  and  anti- 
septic dressing  almost  always  secure  healing. 

GRANULOMA    ON     FOOT    OF    STALLION. 

162.  A  pure  bred  Clj'desdale  stallion. 

History. — The  origin  of  the  growth  was  a  severe  quittor,  which 
affected  the  whole  of  the  subhorny  tissue,  sinuses  running  in  all  direc- 
tions. These  were  successfully  treated,  but  a  gradual  increase  of 
granulating  tissue;  then  occurred  around  the  coronary  band.  For 
about  two  years  this  increase  was  slow  and  interfered  very  little  with 
the  animal's  work,  but  a  sudden  increase  then  occurred,  so  that  in  a 
few  months  the  foot  could  scarcely  be  raised  from  the  ground. 

Although  operation  held  out  little  hope  of  success,  it  was  resolved 
on  for  lack  of  other  remedy. 

Operation. — The  animal  was  cast  and  chloroformed,  a  tourniquet 
was  placed  above  the  hock,  and  the  growth  removed  (with  little 
haemorrhage)  as  completely  as  possible.  As  the  tumour  practically 
encircled  the  foot,  and  extended,  with  oedema,  as  far  as  the  hock-joint, 
it  was  impossible  to  remove  the  whole  of  the  diseased  tissue,  so  that 
only  so  much  was  excised  as  it  was  believed  would  enable  the  animal 


458 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


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GRANULOMA    ON    FOOT    OF    STALLION. 


459 


460 


CLINICAL    VETKRINARV    MEDICINE    AND    SURCiEKV. 


RUPTURE    OF    THE    SESAMOID    LIGAMENTS.  461 

to  walk  with  freedom.  The  portion  removed  was  carefully  weighed 
afterwards,  and  totalled  forty-nine  pounds.  Bleeding  after  removal  of 
the  tourniquet  was  almost  "totally  prevented  by  the  application  of  a 
5  per  cent,  sterilised  solution  of  gelatin,  over  which  was  placed  alem- 
broth  antiseptic  wool,  the  whole  being  bandaged. 

Three  days  afterwards,  when  the  bandages  were  removed,  it  was 
found  that  there  had  been  practically  no  haemorrhage,  and  the  wound, 
which  was  about  twelve  inches  square,  was  perfectly  aseptic.  Unfor- 
tunately the  surface  of  the  growth  was  in  such  a  condition,  and  so 
implicated,  that  no  skin  could  be  dissected  back  wherewith  to  make  a 
flap.  However,  under  careful  attention  an  almost  complete  recovery 
took  place,  scaly  epidermis  gradually  covering  the  scar,  and  three 
months  afterwards  the  animal  presented  the  appearance  seen  in  the 
third  photograph,  which  was  taken  after  he  had  served  a  dozen  mares, 
and  shows  him  in  good  condition.  The  growth,  when  examined  micro- 
scopically, proved  to  be  composed  simply  of  granulation  tissue  of  dense 
fibrous  consistency. 

jMr.  J.  A.  Gilruth's  case,  Veterinarian,  1900,  p.  298. 

RUPTURE    OF    THE    SESAMOID    LIGAMENTS    IN    BOTH    FORE-LIMBS 

IN    THE     HORSE. 

163.  The  subject  was  a  twenty-one-year-old  Anglo-Norman  horse, 
still  in  vigorous  condition,  which  had  been  blistered  both  on  its  front 
and  hind  legs  on  account  of  some  trifling  synovial  enlargements.  A 
fortnight  after  the  second  application  the  horse  was  turned  out  to 
grass,  and,  on  being  set  free,  galloped  round  the  field  several  times. 
It  was  then  left  without  further  supervision.  At  the  end  of  half  an 
hour  it  was  found  lying  down,  in  great  pain,  and  had  to  be  assisted  to 
rise. 

It  remained  standing  for  a  few  seconds,  the  hind  limbs  being 
placed  far  under  the  body,  the  front  excessively  flexed  on  the  fetlock, 
the  ergot  on  which  touched  the  ground,  but  soon  fell.  On  examina- 
tion signs  of  rupture  of  the  flexor  tendons  were  seen  in  both  front 
limbs,  and  the  animal  was  slaughtered. 

Anatomical  Changes.  —  The  tissues  surrounding  the  left  fetlock-joint 
w^ere  swollen  and  hsemorrhagic.  The  perforatus  tendon  was  not 
affected.  Immediately  below  the  point  where  it  emerges  from  the  ring 
formed  by  the  perforatus,  the  perforans  tendon,  however,  was  partially 
torn  through. 

The  external  lateral  sesamoidean  ligament  was  ruptured.  The  sub- 
carpal  ligament  and  the  external  slip,  which  passes  from  it  to  the 
extensor  pedis  tendon,  were  only  slightly  injured,  but  the  internal  slip 
was  ruptured  at  its  point  of  origin.  The  capsular  ligament  w^as  torn, 
thickened,  and  infiltrated  with  blood.  The  sesamoids  were  freely 
moveable,  being  no  longer  fixed  to  the  great  metacarpal,  and  only 
connected  with  the  first  phalanx  by  the  internal  ligaments.  The  inter- 
sesamoidean  ligament  was  ruptured  vertically. 

The  fibrous  expansion  surrounding  the  tendons  at  the  back,  where 
they  pass  over  the  gliding  surface  of  the  sesamoids,  was  ruptured  at  its 
internal  point  of  attachment,  a  portion  of  the  bone  being  torn  away. 


462  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

The'  three  inferior  sesamoidean  hgaments  were  ruptured  on  the 
same  hne  at  their  upper  insertion.  Here  again  the  ligaments  had  torn 
away  the  portion  of  bone  to  which  they  were  attached.  The  internal 
sesamoid  was  fractured  transversel) . 

There  were  no  other  bony  changes.  The  lower  extremity  of  the 
metacarpus  and  the  first  phalanx  were  intact.  The  synovial  capsule 
of  the  joint  was  torn  and  ecchymosed  throughout  the  greater  part  of 
its  surface.  Finally,  there  was  a  great  difference  in  size  between  the 
two  terminal  branches  of  the  superior  sesamoidean  ligament  (suspen- 
sory ligament)  ;  the  internal  was  chronically  inflamed,  and  double  the 
size  of  the  external. 

Most  of  the  lesions  in  the  right  fetlock  were  similar  to  those  above 
described.     Both  sesamoids  showed  comminuted  fracture. 


VI.— INFECTIOUS    DISEASES. 

TUBERCULOSIS    IN    THE    HORSE. 

164.  An  eight-year-old  Percheron  gelding  brought  for  examination, 
April  7th,  1889. 

History. — Had  been  bought  from  a  farmer  in  the  neighbourhood 
of  Chartres  three  years  before,  had  always  appeared  in  good  health, 
and  had  worked  without  stoppage  as  a  heavy  draught-horse. 

Towards  February  15th,  1889,  the  animal  suffered  from  bronchitis, 
from  which  it  recovered  in  a  fortnight.  It  had  returned  to  work  for  a 
week,  and  appeared  in  its  usual  health,  when  one  morning  the  driver 
noticed  at  different  points  a  number  of  subcutaneous  swellings  of 
varying  size,  the  largest  having  the  diameter  of  a  two-shilling  piece  and 
the  thickness  of  a  man's  little  finger.  The  animal  also  seemed  rather 
dull,  and  became  exhausted  more  readily  than  usual.  This  was  the 
history  given  when  the  patient  was  brought  here  a  few  days  later. 

Condition  on  Entry. — At  the  outset  of  our  examination  we  noted 
scattered  over  the  surface  of  the  trunk,  and  of  many  other  regions, 
numerous  swellings,  recalling  at  first  sight  an  outbreak  of  "heat  spots," 
but  distinguishable  from  these  by  their  clinical  characters.  All  were 
firm,  hard,  and  of  fibrous  consistence.  The  majority  had  developed  in 
the  subcutaneous  connective  tissue.  Some  appeared  continuous  with 
the  skin.  In  pursuing  our  examination  we  saw  that  certain  lymphatic 
glands,  corresponding  with  the  affected  zones,  were  enlarged,  spherical 
or  ovoid  in  shape,  moveable  under  the  skin,  and  of  similar  consistence 
to  the  hypodermic  swellings.  Several  of  these  glandular  enlargements 
were  symmetrical,  the  corresponding  glands  of  the  right  and  left  sides 
being  practically  of  the  same  size.  In  some  parts  the  larger  patches 
beneath  the  skin  were  connected  with  the  lymphatic  glands  by  knotted 
cords. 

Towards  the  point  of  the  left  shoulder,  and  over  the  masses  of 
muscle  formed  by  the  extensors  of  the  forearm,  a  lymphatic  chain 
could  be  seen,  extending  from  the  girth  to  the  pre-pectoral  glands  ;  it 
started  from  a  disc-shaped  tumour,  one  to  one  and  a  half  inches  in 
diameter,  three  eighths  of  an  inch  in  thickness,  of  very  firm  and  indo- 
lent character,  and  moveable  under  the  skin.  The  shoulders,  sides, 
flanks,  and  more  particularly  the  croup,  quarters,  and  thighs,  showed 
similar  new  growths,  varying  in  size  between  a  pea  and  a  five-shilling 
piece.  The  inguinal  glands,  especially  those  of  the  left  side,  were  en- 
larged and  indurated.  The  connective  tissue  surrounding  them  was 
slightly  swollen.     None  of  these  lesions  was  at  all  painful. 


464  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

Rectal  exploration  revealed  nothing.  The  sublumbar  lymphatic 
glands  were  normal,  and  no  swelling  was  discovered  in  the  posterior 
portion  of  the  abdominal  cavity  or  in  the  pelvis. 

The  great  functions  were  not  particularly  disturbed.  Had  it  not 
been  for  the  cutaneous  and  subcutaneous  lesions,  the  animal  might 
have  been  thought  in  good  health.  The  rectal  temperature  was 
39-5°  C.  The  urine  was  of  normal  colour,  contained  no  sugar  or  bile 
pigments,  but  was  slightly  albuminous  (about  jh  grains  of  albumen 
per  pint).  There  was  neither  undue  frequence  of  urination  nor  true 
polyuria.  Examination  of  the  blood  showed  no  modification  in  the 
number  or  appearance  of  the  blood-corpuscles. 

One  of  the  subcutaneous  tumours  was  excised  for  histological  exa- 
mination.    The  structure  was  that  of  a  sarcoma. 

Treatment. — Iodide  of  potassium  in  daily  doses  of  4  drachms. 
Some  days  later  the  lymphatics  on  the  left  shoulder  became  inflamed 
in  the  same  way  as  had  those  on  the  right,  but  the  swelling  gradually 
disappeared.  The  animal  was  left  for  a  month  in  hospital.  During 
the  last  fortnight  the  daily  dose  of  potassium  iodide  was  increased  to 
5  drachms.     No  appreciable  improvement  occurred. 

On  May  6th  the  owner  withdrew  the  horse  to  try  it  at  slow  work, 
but  again  brought  it  here  on  June  5th  in  a  very  grave  condition.  The 
appetite  had  diminished  and  the  animal  grown  extremely  weak  ;  the 
slightest  effort  caused  its  breathing  to  become  so  embarrassed  as  to 
bring  it  to  a  standstill. 

We  again  examined  it.  It  appeared  extremely  depressed  and 
feeble.  The  head  was  rested  on  the  manger ;  the  mucous  membranes 
were  pale,  the  skin  dry,  and  the  coat  staring.  The  respirations  were 
36;  pulsations  57  per  minute;  rectal  temperature  39'3^  C.  The 
accelerated  respiration  and  absence  of  fever  caused  us  to  suspect  inva- 
sion of  the  lung  by  the  tumours.  On  auscultation  a  respiratory 
murmur  was  noted  throughout  the  entire  area  of  both  lobes.  There 
was  a  little  partial  dulness  in  the  lower  regions  of  the  thorax. 

The  lymphatic  enlargements  in  the  flank  had  nearly  disappeared, 
but  the  others  remained  almost  as  marked  as  before.  The  pre-pectoral 
and  pre-scapular  glands  were  large,  hard,  and  slightly  sensitive  on 
pressure. 

The  left  surface  of  the  neck,  over  the  region  corresponding  to  the 
mastoido-humeralis  (levator  humeri)  and  of  the  levator  anguli  scapulae 
was  swollen  and  sensitive,  and  the  neck  slightly  turned  to  the  right,  as 
in  luxation  of  the  neck. 

Finally,  one  of  the  fore-limbs  was  frequently  extended  and  placed 
under  the  vertical  line  of  the  body,  giving  the  animal  a  certain  appear- 
ance of  "  immobilite  "  (dropsy  of  the  lateral  ventricle). 

Some  days  later  the  horse  was  exercised  at  a  trot.  It  had  scarcely 
gone  a  few  hundred  yards  w'hen  increasing  difficulty  in  respiration  and 
a  loud  roaring  noise  were  noticed.  Being  threatened  with  the  whip,  it 
continued  trotting  for  about  five  minutes,  and  then  stopped  for  want  of 
breath.  Sweating  was  abundant,  respirations  very  rapid  (70  to  80  per 
minute),  expiration  double,  and  auscultation  revealed  a  respiratory 
murmur  over  the  entire  area  of  both  pulmonar}'  lobes. 


TUBERCULOSIS    IN   THE    HORSE.  465 

After  its  return  to  hospital  some  of  the  tumours  had  disappeared, 
a  few  completely  ;  but  others  had  grown  and  continued  to  enlarge. 

The  animal  appeared  incurable,  and  was  slaughtered  a  few  days 
later. 

Autopsy. — The  lesions  found  on  post-mortem  examination  were  more 
generalised  than  had  at  first  been  supposed.  On  dissecting  away  the 
skin  numerous  small  tumours,  scattered  through  the  subcutaneous 
tissue,  were  seen  at  some  points  discrete,  at  others  more  closely 
placed.  A  certain  number  were  continuous  with  the  corium.  The 
smallest  of  these  tumours  was  the  size  of  a  pea,  the  largest  the  size  of 
the  yolk  of  an  egg.  The  majority  were  rounded,  firm,  and  of  fibrous 
consistence. 

Here  and  there  traces  of  the  above-mentioned  lymphangitis  could 
be  noted.  The  lymphatic  glands  at  the  entrance  of  the  chest  were 
enlarged,  and  formed  two  lobes,  each  the  size  of  a  walnut. 

Graver  lesions,  which  had  not  been  suspected  during  life,  existed  in 
the  muscles  and  viscera. 

A  large  number  of  the  muscles  showed  bands  of  sclerotic  tissue 
and  little  rice-like  whitish  nodules.  These  growths  were  very  abundant 
in  the  levator  anguli  scapulae,  the  rhomboideus,  the  extensors  of  the 
neck,  the  small  oblique  muscles  of  the  abdomen,  but  especially  in  the 
adductors  of  the  two  hind  limbs,  and  in  the  superficial  glutei,  these  two 
last  muscular  groups  being  crowded  with  them. 

On  opening  the  abdominal  cavity  certain  viscera,  particularly  the 
liver  and  spleen,  were  seen  to  be  invaded  by  these  tumours.  The  liver 
and  spleen  were  crowded  with  fine  granulations  ;  the  spleen,  in  addi- 
tion, contained  three  tumours  the  size  of  a  walnut.  The  peritoneum 
covering  the  stomach  showed  a  collection  of  granulations  resembling 
recent  tuberculous  growths.  Of  the  various  abdominal  lymphatic 
glands  the  sublumbar  alone  were  affected.  They  formed  an  ovoid 
mass,  the  size  of  a  man's  fist,  which  had  not  been  detected  on  rectal 
exploration. 

The  other  abdominal  viscera,  together  with  the  lung,  heart,  pleura, 
nervous  centres,  and  bones,  were  free  of  these  growths. 

Histological  examination  extended  to  the  muscles,  skin,  liver,  and 
spleen.  The  diseased  muscles  showed  the  same  characters  as  in  tuber- 
culous cirrhosis  of  muscle.  In  the  skin,  liver,  and  spleen  the  tubercles 
contained  a  large  number  of  giant-cells.  They  tended,  especially  those 
in  the  spleen,  towards  fibrous  change,  and  were  exceedingly  poor  in 
tubercle  bacilli. 

164.  A  seven-3-ear-old  entire  horse,  brought  to  the  school  on  the 
8th  May,  i8g6,  for  castration. 

History. — The  horse  had  been  bought  in  1894.  At  that  time  the 
scrotum  was  large,  but  the  seller  declared  the  condition  to  be  con- 
genital. The  animal  worked  well  until  February,  1896,  when  the 
scrotum  became  swollen  and  appeared  to  interfere  with  movement ;  the 
patient  fell  away  in  condition.     Castration  was  decided  on. 

Condition  on  Entry. — At  first  glance  this  horse  appeared  in  good 
health.      The  right  testicle  was  much  larger  than  the  left.     Its  en- 

G  G 


466  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 

velopes  were  thickened  and  oedematous,  but  only  slightly  adherent  to 
the  gland  itself.  No  change  could  be  discovered  in  the  cord.  On  the 
left  side  the  envelopes  were  also  swollen ;  the  testicle,  however,  ap- 
peared normal.  Rectal  examination  showed  no  enlargement  of  the 
sublumbar  glands.     The  animal  did  not  react  to  mallein. 

On  the  nth  May  the  animal  was  cast  on  the  table  and  fixed  for 
castration.  After  careful  disinfection  of  the  parts  the  right  testicle 
was  removed  by  crushing  the  cord.  There  was  very  little  haemor- 
rhage, and  no  dressing  was  employed.  ■ 

The  testicle  was  double  the  normal  size.  On  incision  its  tissue 
appeared  little  changed.  This  was  not  the  case,  however,  with  the 
epididymis,  the  termination  of  which  had  been  transformed  into  a 
tumour  the  size  of  an  orange,  formed  of  whitish,  firm,  fibrous  tissue. 
The  cord  appeared  healthy,  except  over  its  serous  surface,  where  it  was 
covered  with  small  reddish  granulations. 

During  the  night  and  following  days  the  wound  was  cleansed  with 
warm  sublimate  solution.  Swelling  of  the  sheath  increased  until  the 
20th  May,  after  which  it  diminished,  and  the  wound  appeared  to  be 
healing  regularly. 

On  the  29th  the  swelling  resulting  from  operation  had  greatly 
diminished,  but  the  envelopes  of  the  left  testicle  were  thicker  and  more 
infiltrated  than  at  the  time  of  entry.  The  testicle  was  removed.  Enu- 
cleation was  rendered  somewhat  difficult  by  the  induration  of  the  sub- 
dartoid  connective  tissue.  The  cord  was  divided  with  the  ecraseur, 
haemorrhage  being  trifling  and  of  short  duration. 

The  testicle  was  about  one  third  larger  than  normal.  The  glandular 
tissue  was  infiltrated.  The  part  of  the  cord  removed  was  enlarged, 
and,  like  the  right  cord,  covered  with  small  vegetations.  The  vaginal 
sheath  contained  a  little  reddish  liquid. 

During  the  following  days  the  animal's  general  condition  and  appe- 
tite remained  good,  though  fever  existed,  the  temperature  varying  be- 
tween 39*4°  and  39'8°  C.  There  was  considerable  oedema  about  the 
wound,  the  swelling  extending  four  inches  beyond  the  front  of  the 
sheath. 

The  general  condition  remained  stationary  until  the  nth  June,  and 
no  disquieting  symptoms  occurred. 

On  the  I2th  the  morning  temperature  was  39*2°  C,  evening  39*6°  C. 
During  the  day  the  animal  appeared  depressed  and  spiritless,  but  ate 
all  its  food.     Next  morning  it  was  found  dead  in  its  stall. 

Autopsy. — The  castration  wounds  were  granulating  throughout. 
The  external  envelopes  were  about  two  inches  and  a  half  to  three 
inches  and  a  quarter  in  thickness,  and  engorged  with  serosity.  At  the 
base  of  the  operation  wound  in  each  division  of  the  scrotum  was  a 
rounded  swelling,  the  size  of  an  apple,  formed  by  the  end  of  the  cord, 
which  was  dense,  firm,  and  of  fibrous  appearance  on  section.  Both 
cords  were  covered  with  little  whitish  swellings,  and  vegetations  similar 
to  those  found  in  the  parts  removed.  The  sheath  was  enlarged  and 
oedematous,  but  without  special  feature. 

Abdominal  Cavity  :  The  great  omentum  was  riddled  with  tubercles, 
hard  or  soft   in  consistence  and  isolated  or  massed  together  in  the 


TUBERCULOSIS    IN    THE    HORSE.  467 

form  of  larger  or  smaller  "  grapes."  The  peritoneum  covering  the 
posterior  surface  of  the  diaphragm  was  covered  with  whitish  tumours, 
the  largest  the  size  of  a  hazel-nut,  some  isolated,  others  collected  in 
patches  of  varying  extent  and  thickness ;  all  were  dense,  firm,  and 
without  softened  centres  :  though  abundant  at  the  limit  between  the 
aponeurotic  and  muscular  portions,  they  were  rare  on  the  muscular 
part  itself.  Opposite  the  stomach  was  a  patch  measuring  twelve  inches 
in  length,  six  inches  in  breadth,  and  two  to  two  and  a  quarter  inches 
in  thickness. 

The  spleen  was  double  its  normal  size,  and  of  a  lilac  tint ;  its 
surface  was  irregular.  Its  substance  contained  seven  large,  firm, 
uniformly  hard  tumours,  three  the  size  of  an  orange,  the  others  as  large 
as  an  egg,  all  of  yellowish-white  colour,  and  showing  on  section  a  few 
calcified  points.  The  base  of  the  organ  was  infiltrated  with  granula- 
tions. The  splenic  lymphatic  glands  were  hypertrophied.  The  gastro- 
splenic  omentum  was  covered  with  tubercles  containing  caseous 
centres. 

The  liver  was  of  enormous  size,  yellowish  colour,  and  showed  both 
on  its  surface  and  on  sections  numerous  tubercles,  varying  in  dimen- 
sions between  a  pin's  head  and  a  pea,  all  firm  and  without  signs  of 
degeneration. 

The  kidneys  were  unaffected. 

The  mucous  membrane  of  the  large  colon  was  healthy  throughout 
the  greater  part  of  its  extent.  Along  the  diaphragmatic  curvature  for 
a  length  of  twenty  to  twenty-four  inches,  and  at  a  few  other  points 
were  numerous  ulcerations,  the  majority  as  large  as  sixpence,  sur- 
rounded by  reddish  aureolas.  In  the  small  colon  and  small  intestine 
were  several  similar  ulcerations. 

All  the  lymphatic  glands  in  the  abdominal  cavity  were  enlarged  ; 
many  showed  softened  caseous  centres.  The  sublumbar  lymphatic 
glands  were  relatively  little  swollen,  but  appeared  caseous  on  section. 

Thoracic  Cavity :  The  lungs  were  enlarged,  firm  to  the  touch,  and 
packed  with  recent  greyish  non-caseous  granulations.  The  pulmonary 
tissue  was  unchanged  except  in  the  lower  third  of  the  lobes,  which 
exhibited  a  zone  of  hepatisation.  The  bronchi  and  trachea  showed  no 
lesions.     The  bronchial  glands  were  scarcely  enlarged. 

Like  the  epiploon,  the  mediastinum  was  thickened  and  covered  with 
tubercles.     The  other  portions  of  the  pleura  were  little  changed. 

Both  layers  of  the  pericardium  were  thickened  and  dotted  over  with 
granulations.  In  the  left  heart  the  endocardium  was  whitish,  thick- 
ened, furrowed,  and  contracted.  The  mitral  and  aortic  valves  were 
thickened  and  infiltrated.  In  the  myocardium,  below  the  anterior 
sigmoid  valve,  was  a  tuberculous  abscess  as  large  as  a  nut.  The  aorta 
and  its  branches  showed,  several  atheromatous  patches.  On  bacterio- 
logical examination  bacilli  proved  numerous  in  the  caseous  material 
from  the  lymphatic  glands  and  in  the  fluid  obtained  by  scraping  the 
ulcerations,  and  fairly  numerous  in  the  pulmonary  granulations,  but 
rare  in  the  endocardium.     They  were  also  discovered  in  the  fasces. 

With  an  emulsion  prepared  by  crushing  in  sterilised  water  a  frag- 
ment of  the  sublumbar  lymphatic  gland  and  a  small  tuberculous  centre 


468  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 

from  the  epiploon,  the  following  animals  were  intra-peritoneally 
injected  : — a  dog  (5  cubic  centimetres),  a  rabbit  (2  cubic  centimetres), 
two  guinea-pigs  (i  cubic  centimetre),  and  two  fowls  (2  cubic  centi- 
metres). 

The  dog  was  killed  on  the  2gth  July,  forty-seven  days  later. 

Atiiopsy. — Numerous  granulations  on  the  peritoneum  and  epiploon. 
The  latter  was  greatly  indurated,  being  as  thick  as  a  man's  hand  in  the 
neighbourhood  of  the  spleen.  Enlargement  of  the  mesenteric,  medias- 
tinal, and  tracheo-bronchial  glands.  Granulations  in  the  liver  and 
lung. 

The  rabbit  died  on  the  25th  September,  104  days  after  inoculation. 

Autopsy. — Generalised  tuberculosis.  Enormous  lesions  in  the  peri- 
toneum, epiploon,  mesenteric  glands,  kidneys,  testicle,  and  prostate. 

One  of  the  guinea-pigs  died  on  the  25th  June,  after  thirteen  days. 
Bacteriological  examination  of  the  pulp  of  the  liver  and  spleen 
revealed  the  presence  of  bacilli  in  these  organs. 

The  other  died  on  the  4th  July,  after  twenty-two  days.  It  was 
already  much  wasted,  and  showed  lesions  of  tuberculosis  in  course  of 
generalisation, — fine  granulations  in  the  peritoneum,  hypertrophy  of 
the  epiploon,  and  granulations  in  the  kidney  and  spleen,  which  last 
was  five  times  its  normal  size.  Two  other  guinea-pigs  were  injected 
with  an  emulsion  prepared  by  crushing  a  little  spleen  pulp  in  sterilised 
water.  The  first  died  on  the  ist  October,  after  eighty-nine  days  ;  the 
other  on  the  13th  October,  after  loi  days.  Both  showed  on  post-mortem 
generalised  lesions  with  enormous  enlargement  of  the  spleen. 

The  fowls  were  killed  on  the  i6th  June,  1898,  after  two  years  and 
four  months.     No  tuberculous  lesion  was  found  on  post-mortem. 

165.  A  ten-year-old  grey  cart  mare,  seen  on  the  8th  January, 
1898. 

History. — During  the  last  week  of  December,  1897,  this  animal 
appeared  dull,  unwell,  and  was  not  feeding.  Several  other  horses 
in  the  stable  were  not  thriving  or  eating  well,  but  the  above  animal  was 
the  worst,  and  while  medical  treatment  and  better  food  improved  the 
others  this  mare  remained  unaffected.  There  were  no  acute  S3'mptoms, 
but  the  disease  appeared  indefinite,  chronic,  and  progressive. 

State  on  Examination. — Appeared  in  fair  condition,  and  at  first  sight 
showed  no  disquieting  symptoms.  Pulse  56  and  of  fair  strength ; 
respirations  25 ;  temperature  103°  F.  Auscultation  of  the  chest 
revealed  a  harsh  respiratory  murmur,  indistinct  towards  the  lower 
part ;  percussion  everywhere  indicated  increased  dulness,  which  towards 
the  floor  of  the  chest  was  almost  absolute.  Cough  was  almost  com- 
pletely absent. 

Apart  from  the  history  of  gradual  onset  and  the  comparatively 
slight  fever  and  injection  of  the  conjunctivae  this  case  might  have  been 
mistaken  for  influenza  with  supervening  pneumonia.  The  symptoms 
failed  to  indicate  the  rapidity  with  which  the  disease  was  progressing 
until  shortly  before  death  on  the  19th  January. 

Post-mortem  Examination. — The  lungs  alone  were  diseased.  The 
pleurae  were  healthy,  but  the  lungs  on  removal  were  very  heavy  and 


TUBERCULOSIS    IN    A    COW,  469 

felt  very  lumpy,  owing  to  the  presence  of  nodules  varying  in  size 
between  a  bean  and  a  bantam's  egg.  Some  were  cheesy  throughout, 
others  contained  pus.  All  portions  of  the  lung  were  diseased,  the 
posterior  and  inferior  borders,  which  were  much  thickened,  being  the 
parts  most  affected. 

A  portion  of  lung  examined  by  Professor  Dewar  was  yellowish 
white  in  colour,  the  pleura  thickened  and  opaque,  the  parenchyma 
completely  hepatised,  or  rather  solidified,  and  requiring  close  and 
careful  examination  to  identify  it  as  lung.  At  first  sight  it  seemed  the 
product  of  an  interstitial  pneumonia.  On  section  the  parenchyma  was 
of  a  light  salmon  colour,  the  interlobular  tissue  white  and  in  some  parts 
slightly  translucent,  but  all  completely  solidified.  Microscopic  exami- 
nation revealed  numerous  tubercle  bacilli. 

Note. — This  case  is  interesting  because  (i)  infection  appears  to 
have  occurred  by  the  respiratory  tract,  and  not  through  the  digestive 
organs ;  (2)  the  disease  was  confined  to  the  lungs,  not  even  the  pleura 
(?)  being  attacked;  (3)  because  of  its  acuteness ;  nothing  was  suspected 
until  the  end  of  December,  within  three  weeks  of  which  date  the 
animal  died. 

Prof.  Dewar's  case,  Veterinarian,  1S9S,  p.  155. 

TUBERCULOSIS    IN    A    COW— INFLAMMATION    OF    THE    OMASUM    AND 
ULCERATION    OF    THE    ABOMASUM. 

166.  A  six-year-old  shorthorn  cow. 

History. — Until  within  three  days  before  examination  the  animal 
had  appeared  fairly  healthy. 

State  on  Examination. — Symptoms  of  advanced  pulmonary  and 
pleuritic  tuberculosis,  with  pulmonary  emphysema ;  the  nose  was  pro- 
truded, the  breathing  laboured  and  accompanied  by  grunting ;  the 
chest  was  painful  on  palpation,  and  there  was  constant  coughing.  The 
anterior  quarters  of  the  udder  were  somewhat  swollen  and  hard,  the 
milk  rather  thin  and  slightly  blue  in  tint.  The  appetite  was  moderately 
good.  The  bowels  were  relaxed.  Temperature  io6°  F.  ;  marked 
jugular  pulse. 

Microscopic  examination  of  the  milk  failed  to  detect  any  tubercle 
bacilli.     Tuberculin  gave  only  a  slight  reaction. 

The  symptoms  becoming  aggravated,  the  animal  was  shot. 

A  utopsy. — The  whole  of  the  omentum  was  intensely  hsemorrhagic 
and  hyperaemic,  the  colour  varying  from  bright  red  to  a  modena  hue. 
Every  stage  of  tubercular  new  growth,  from  bright  red  villous  growths 
to  yellow  nodules,  and  even  polypoid  bodies  were  present.  There  was 
little  peritoneal  effusion,  and  comparatively  few  tubercular  nodules  on 
the  peritoneum.  The  kidneys,  liver,  spleen,  and  pancreas  were  macro- 
scopically  free  from  tubercle,  and  the  mesenteric  glands  only  slightly 
affected. 

The  small  and  large  bowels,  except  the  caecum,  were  healthy  ;  the 
walls  of  the  caecum,  however,  were  enormously  thickened  and  inflamed, 
and  the  lumen  of  the  gut  materially  diminished. 

On  opening  the   abomasum  the  pyloric  portion  showed  consider- 


47°  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY, 

able  congestion  and  several  circular  ulcers  with  thickened  bases, 
var3ang  in  size  from  a  split  pea  to  a  sixpence.  In  addition,  an  intra- 
nasal growth  of  the  size  and  shape  of  a  pigeon's  egg  and  homogeneous 
on  section  was  detected. 

The  lungs  were  enormous,  intimately  adherent  to  the  ribs,  and 
riddled  with  tubercular  broncho-pneumonia  lesions  ;  the  right  lung  was 
oedematous. 

The  omental  lesion  was  probably  secondary  to  the  pleural.  The 
condition  was  evidently  highly  infective.  The  udder  showed  character- 
istic tubercular  inflammation  in  the  hardened  and  enlarged  quarters. 
Professor  Walley  was  unable  to  recall  another  instance  of  gastric  lesions 
in  the  ox. 

Prof.  Walley's  case,  Joiirn.  Conip.  Path,  and  Therap.,  1893,  p.  87. 

TUBERCULOSIS  OF  THE  CEREBRUM. 

167.  A  five-year-old  shorthorn  cow,  first  seen  August  29th,  1895. 

History. — Had  had  three  calves,  the  last  on  April  15th,  1895.  About 
the  end  of  June  the  animal  had  been  out  at  grass,  and  appeared  to  be 
suffering  from  cold ;  it  was  treated  and  seemed  to  recover.  On  the 
evening  of  August  28th  it  fed  well  and  yielded  the  ordinary  amount  of 
milk.     On  the  29th  it  was  thought  to  be  choking. 

State  on  Exainination. — Temperature  98°  F.,  pulse  44,  respirations 
hurried  ;  bowels  constipated ;  extremities  very  cold ;  the  animal  was 
coughing,  and  appeared  very  excited.  The  throat  seemed  swollen,  and 
sore  throat  was  suspected. 

Treatment. — As  water  was  readily  swallowed,  a  purgative  draught 
was  administered.  A  cantharides  blister  was  applied  to  the  throat,  the 
animal  was  well  covered  up,  and  linseed  gruel  was  given  to  drink. 

In  the  evening  the  temperature  was  101°  F.,  pulse  54.  The  nose 
was  protruded  and  held  high,  the  eyes  appeared  excited  and  the  pupils 
were  dilated.  When  gruel  was  offered  the  animal  seemed  anxious  to 
drink,  but  could  not  put  its  nose  in  the  bucket.  It  staggered  when 
moved. 

August  30th. — The  eyes  had  become  cloudy,  there  was  marked 
strabismus  and  slight  lachrymation.  Some  brain  disease — probabl}'  a 
tumour — was  diagnosed,  but  as  some  doubt  was  felt  as  to  its  exact 
nature,  the  poll  was  blistered,  and  cold  applications  made  to  the 
forehead. 

August  31st. — The  condition  was  much  aggravated,  and  symptoms 
of  paralysis  gradually  set  in.  Periods  of  excitation  alternated  with 
prostration.  As  the  animal  afterwards  became  comatose  slaughter  was 
advised. 

The  client  continued  the  cold  applications  and  gruel  until  next 
afternoon,  when,  losing  hope,  he  had  the  animal  killed. 

Autopsy. — The  head  and  neck  alone  were  examined.  On  removing 
the  skull-cap  and  incising  the  dura  mater  a  quantity  of  sero-sanguine- 
ous  fluid  was  found  in  the  subdural  space.  Except  for  a  certain 
amount  of  hypersemia  the  meninges  were  normal. 

The  brain  was  much  congested,  showed  haematoidin  pigmentation. 


TUBERCULOSIS    IN    THE    DOG.  47 1 

and  the  ris^ht  hemisphere  appeared  softened.  In  the  anterior  and 
upper  portion  of  the  left  hemisphere  a  superficial  depression  was 
observed,  the  discoloration  being  more  marked  over  that  area.  Incision 
through  this  depression  revealed  a  very  large  tubercular  nodule.  The 
tumour  was  about  the  size  of  a  walnut,  caseated,  and  undergoing 
calcification.  The  cut  surface  was  of  a  dirty  yellow  colour,  and  showed 
numerous  calcareous  particles,  rather  larger  than  coarse  sand. 

The  submaxillary  lymphatic  glands  were  tuberculous. 

Microscopic  examination  of  the  brain  revealed  the  presence  of 
tubercle  bacilli. 

Note. — The  most  striking  points  in  the  case  are  (i)  the  sudden 
development  of  symptoms,  a  characteristic  also  commonly  noted  in 
tuberculous  children  ;  (2)  the  subnormal  temperature  ;  (3)  the  absence 
of  tubercular  meningitis  ;  and  (4)  the  good  bodily  health  and  condition 
of  the  patient. 

Mr.  A.  R.  Routledge's  case,  Veterinarian,  1895,  p.  504* 

EXTERXAL    LESIOXS    OF    TUBERCULOSIS    IX    THE    DOG. 

168.  A  two-year-old  Havanese  bitch,  brought  for  examination  on 
the  ist  May,  1894,  suffering  from  a  sinuous  wound  in  the  neck. 

Three  months  before,  a  swelling  had  appeared  in  the  upper  part  of 
this  region,  and  had  increased  in  size  until  it  became  as  large  as  an 
egg.  After  poulticing  it  softened  and  ulcerated,  discharging  pus,  at 
first  freely,  and  afterwards  in  less  quantity.  The  wound  became 
sinuous,  was  treated  by  antiseptic  injections,  and  had  several  times 
been  laid  open. 

State  on  Examination. — The  patient  was  fairly  well  nourished.  On 
examining  the  abdominal  and  thoracic  cavities  no  symptom  suggesting 
tuberculosis  was  noted. 

Over  the  median  line  of  the  larynx  was  a  wound,  as  large  as  a 
sixpence,  the  margins  of  which  were  torn  and  irregular,  separated 
from  the  deeper  seated  tissues,  thickened,  exuberantly  granulating,  at 
certain  points  thin,  at  others  eroded,  but  in  all  parts  covered  with 
greyish  viscous  pus.  Two  little  sinuses  opened  at  the  base  of  the 
wound  and  extended  deeply  along  the  sides  of  the  trachea.  Slightly 
below  this  first  wound  was  another,  similar  in  size,  also  sinuous  in 
character,  and  separated  from  the  first  by  a  fragment  of  skin  about 
two  and  a  half  inches  wide.  On  the  left  surface  of  the  neck,  behind 
the  lower  portion  of  the  parotid,  was  a  cold  abscess,  as  large  as  a  hazel- 
nut. When  punctured  it  discharged  greyish  watery  pus,  which,  like 
that  collected  from  the  wounds,  contained  tubercle  bacilli. 

This  animal  was  not  left  in  hospital  or  brought  back  again  for 
examination, 

i6g.  A  four-year-old  bitch,  several  times  brought  to  the  external 
chnique  during  the  early  part  of  1894.  Belonged  to  a  tuberculous 
person. 

Had  been  ill  since  the  end  of  January.  The  owner  had  particularly 
noticed   coughing   and    rapid   emaciation,  followed    by  diarrhoea   and 


472  CLINICAL   VETERINARY    MEDICINE    AND    SURGERY. 

dysenter}'.  In  March  a  nasal  discharge,  sometimes  streaked  with  blood, 
appeared  and  continued  until  death. 

At  the  commencement  of  April  an  abscess  developed  on  the  left 
side  of  the  upper  part  of  the  neck.  The  wound  left  on  puncture, 
refused  to  heal,  and  finally  became  sinuous.  A  fortnight  later  another 
abscess  occurred  on  the  opposite  side,  practically  at  the  same  level  as 
the  first.     It  opened  spontaneously  and  became  sinuous. 

These  sinuses,  about  one  to  one  and  a  half  inches  in  depth, 
suppurated  somewhat  abundantly  for  two  months.  The  skin  sur- 
rounding them  was  denuded  of  hair  and  separated  from  the  subjacent 
tissues.  The  whole  of  the  laryngeal  region  became  swollen  and  indu- 
rated. 

At  the  commencement  of  July  appetite  was  entirely  lost,  and 
wasting  made  rapid  progress.  The  patient  died  on  the  17th  July, 
1894.     The  body  was  brought  to  the  school. 

Autopsy. — Diffuse  pulmonary  tuberculosis  wdth  formation  of  nume- 
rous cavernous  spaces  ;  inflammation  of  the  tracheo-bronchial  glands  ; 
tuberculosis  of  the  liver. 

The  larynx  and  origin  of  the  trachea  were  surrounded  by  a  thick 
layer  of  tissue  resembling  sarcoma,  excavated  by  several  tracts. 
Sections  through  this  tissue  showed  yellowish-grey  tubercles  and 
several  little  purulent  centres.  There  was  no  apparent  tuberculous 
lesion  in  the  buccal,  nasal,  pharyngeal,  or  laryngeal  mucous  mem- 
branes. 

Throughout  the  lower  two  thirds  of  the  neck  the  lymphatic  vessels 
were  affected  on  either  side  of  the  trachea,  several  enlargements,  the 
size  of  a  haricot  bean  to  that  of  a  hazel-nut,  being  found. 

Pus  from  the  fistulse  contained  numerous  bacilli. 

170.  A  seven-year-old  spaniel  bitch,  brought  for  examination  on 
the  6th  April,  1895.  Had  been  ill  for  three  months  previously.  The 
principal  symptoms  were  loss  of  appetite,  wasting,  and  gradually 
advancing  feebleness.  About  two  months  before  the  bitch  had  suffered 
for  a  fortnight  from  cough,  and  from  a  greyish  discharge  from  both 
nostrils. 

State  on  Examination. — The  patient  was  exceedingly  emaciated, 
feeble  and  dull,  in  fact,  a  characteristic  example  of  advanced  tuber- 
culosis. Nothing  abnormal  could  be  detected  on  examining  the 
abdominal  cavity.  The  right  wall  of  the  chest,  however,  behind  the 
shoulder  showed  an  ovoid  swelling,  the  longer  axis  of  which  was 
vertical,  covering  four  ribs  and  the  corresponding  intercostal  spaces. 
It  was  firm,  and  towards  its  periphery  almost  hard.  Near  the  centre 
was  a  narrow  sinus  discharging  greyish  pus,  in  which  microscopical 
examination  detected  tubercle  bacilli. 

The  animal  was  left  for  observation,  and  was  killed  on  the  15th  April. 

Autopsy. — Old-standing  pulmonary  tuberculosis  with  formation  of 
cavernous  spaces.  Tuberculosis  of  the  pleura  ;  double  parietal  pleural 
adhesions.  On  the  right  side  the  costal  pleura  was  much  thickened 
and  covered  with  vegetations.  On  incising  it  opposite  the  costal 
abscess  a  somewhat   extensive  cavity  was   opened,  the   internal  wall 


TUBERCULOSIS    IN    THE    CAT.  473 

formed  by  the  thickened  pleura,  the  external  by  the  eighth,  ninth,  and 
tenth  ribs,  which  were  denuded  of  pleura,  inflamed,  and  at  some  points 
softened.  Over  the  ninth  and  tenth  intercostal  spaces  this  cavity 
communicated  with  the  external  swelling  seen  during  life.  It  contained 
a  little  greyish  pus  and  fragments  of  necrotic  tissue. 

171.  A  fifteen-month-old  spaniel,  brought  to  Alfort  on  the  6th  July, 
i8g6,  to  be  killed.  Had  been  ill  for  about  a  year,  and  showed  a 
suppurating  wound  on  the  neck,  which  had  been  unsuccessfully  treated 
for  a  long  time. 

Autopsy. — Tuberculosis  of  the  liver;  old  standing  pulmonary 
tuberculosis  with  cavern  formation.  The  wound  in  the  neck,  over  the 
origin  of  the  trachea,  was  rounded,  ulcerated,  and  the  size  of  a  two- 
shilling  piece.  Its  margins  were  denuded  of  hair,  and  the  skin  was 
thinned  and  separated  from  subjacent  tissues.  Its  base  showed  a  sinus, 
which  extended  as  deep  as  the  left  retro-pharyngeal  glands.  These 
formed  a  swelling  the  size  of  a  pigeon's  egg,  were  hard,  and  firmly 
attached  to  the  surrounding  parts.  The  sinus  had  originated  in  several 
small  purulent,  caseating  nodules  at  this  point.  The  lower  half  of  the 
left  tonsil  was  destroyed  by  an  ulcer,  with  a  yellowish,  finely  granular 
base  and  indurated  margins. 

The  tuberculous  character  of  the  wound  in  the  neck,  the  inflamma- 
tion of  the  retro-pharyngeal  glands,  and  the  ulcer  in  the  tonsil  was 
proved  by  the  discovery  of  bacilli  in  each  of  these  lesions. 

TUBERCULOSIS    IN    THE    CAT. 

172.  A  one-year-old  female  cat,  brought  for  examination  on  the 
igth  June,  1894. 

The  history  was  as  follows : — About  six  weeks  previously  this  cat 
had  shown  signs  of  chest  disease,  particularly  cough  and  difficulty  in 
respiration,  followed  by  loss  of  appetite  and  wasting.  For  three  days 
before  the  animal  had  not  touched  food. 

This  history,  together  with  the  results  of  clinical  examination,  and 
the  chronic  character  of  the  disease,  caused  us  to  suspect  tuberculosis. 
The  owner  would  not  allow  the  animal  to  be  left,  but  brought  it  back, 
however,  on  the  7th  July,  when  it  was  killed. 

Autopsy.— Over  the  terminal  portion  of  the  small  intestine  were 
some  tuberculous  lymphatic  glands,  the  size  of  hazel-nuts.  In  front 
of  these  were  five  smaller  lymphatic  glands  arranged  like  a  row  of 
beads,  parallel  to  the  intestine.  The  epiploon  showed  a  few  tubercles 
as  large  as  peas.  The  mucous  membrane  of  the  ileum  exhibited  two 
ulcerations :  one,  oval  in  form,  with  its  longer  diameter  parallel  to  the 
intestine,  measured  half  an  inch  in  length  and  three  eighths  in 
breadth  ;  the  other  was  narrower,  with  indurated  prominent  margins. 
Liver  large,  crammed  with  greyish  tubercles,  the  size  of  millet  seeds, 
at  certain  points  confluent ;  on  the  posterior  surface  of  the  organ 
hundreds  could  be  counted.  Spleen  three  times  the  normal  size,  both 
surfaces  bosselated  by  tubercles,  some  as  large  as  a  pea.  The  lungs 
were  firm,  dense,  fibrous,  and  greyish  in   colour  ;  showed  generahsed 


474  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 

lesions  in  both  lobes,  and  on  section  numerous  tubercles  and  tracts  of 
caseated  pneumonia.     All  the  lesions  were  very  rich  in  bacilli. 

173.  An  eight-year-old  female  cat,  brought  for  examination  the  2nd 
December,  1895  ;  had  been  ill  for  several  weeks.  This  cat  belonged  to 
a  lady,  one  of  whose  children  had  died  of  tuberculosis  a  few  months 
before.  The  animal  was  dull,  weak,  thin,  and  showed  enlargement  of 
the  abdomen. 

The  enlargement  was  due  to  dropsy.  The  abdomen  was  punctured^ 
and  twelve  and  a  half  ounces  of  liquid,  which  gave  a  greyish  deposit, 
were  drawn  off.  No  bacilli  were  discovered  in  this  deposit  on  micro- 
scopic examination.  Two  guinea-pigs  were  intra-peritoneally  injected 
with  one  cubic  centimetre  of  the  liquid. 

On  the  14th  December  the  patient  was  brought  back,  the  owner 
stating  that  it  had  improved,  but  that  the  ascites  had  returned.  The 
abdomen  was  again  punctured,  about  eight  ounces  of  fluid,  similar  to 
the  first,  being  removed. 

The  patient  was  not  afterwards  seen. 

On  the  15th  January,  1896,  the  guinea-pigs  were  killed.  On  post- 
mortem tuberculous  granulations  were  found  in  the  liver  and  spleen,, 
and  on  the  peritoneum. 

174.  A  seven-year-old  cat,  brought  for  examination  March  17th,. 
1896.     Had  been  ill  for  more  than  a  year. 

Belonged  to  a  lady  who  died  of  tuberculosis.  It  had  shown  loss  of 
appetite,  cough,  depression,  a  little  nasal  discharge,  and  progressive 
wasting.  This  cat  seldom  left  its  owner's  rooms,  passing  the  greater 
portion  of  its  time  in  the  bedroom.  It  was  sometimes  fed  with  meat, 
etc.,  left  by  its  owner  ;  sometimes  with  horse-flesh. 

The  animal  was  ver}'  greatly  wasted  ;  the  respiration  was  rapid  and 
difficult,  and  crepitant  rales  were  noted  on  auscultating  the  lungs.  It 
was  left  here  and  killed. 

Autopsy. — Almost  the  whole  of  both  pulmonary  lobes  was  cede- 
matous.  Both  on  the  surface  and  on  sections  numerous  tubercles 
could  be  seen,  some  were  firm,  others  softened  and  caseous.  The 
lesions  were  rich  in  bacilli. 

175.  A  three-year-old  cat,  brought  for  examination  November  24th, 
1896.  It  had  been  ill  for  several  weeks  ;  was  dull,  thin,  and  generally 
remained  lying  down.  The  appetite  was  capricious,  sometimes  the 
animal  altogether  refused  food ;  it  had  been  principally  nourished  on 
raw  meat  and  milk.  The  excessive  emaciation  and  the  chronic  cha- 
racter of  the  disease  suggested  tuberculosis.  The  owner,  tired  of 
nursing  the  animal,  allowed  it  to  be  killed. 

Autopsy. — The  epiploon  was  dotted  over  with  fine  granulations. 
The  terminal  portion  of  the  small  intestine,  the  caecum  and  first  part 
of  the  colon  were  surrounded  by  an  indurated  mass,  formed  by  en- 
larged lymphatic  glands  adhering  to  the  walls  of  the  intestine.  In- 
cision of  the  latter  showed  the  mucous  membrane  to  be  thickened  and 
ulcerated  at  several  points.     The  tissue  of  the  glandular  swelling  was. 


TRANSMISSION    OF    TUBERCULOSIS    FROM    MAN    TO    THE    CAT.  475 

softened  and  at  places  caseous.  The  liver  and  spleen  showed  granula- 
tions ;  the  pleura  was  dotted  with  vegetations,  and  both  lungs  con- 
tained recent  tubercles.  Bacilli  were  found  in  the  pus  from  the  swell- 
ing formed  b}'  the  lymphatic  glands. 

TRANSMISSION  OF  PULMONARY  TUBERCULOSIS  FROM  MAN  TO 

THE  CAT. 

176.  In  June,  1887,  Dr.  Leon  Petit  described  two  cases  of  trans- 
mission of  tuberculosis  to  dogs  from  their  owners  attacked  with  pul- 
monary phthisis.  The  first  was  that  of  a  dog  which  ate  the  sputum, 
etc.,  of  a  phthisical  person  ;  the  second  referred  to  a  dog  which  had 
lived  for  several  months  in  a  close  room  in  which  its  mistress  slowly 
died  of  phthisis.  On  autopsy  both  showed  tuberculous  pleurisy  and 
invasion  of  the  pulmonar}-  tissue,  and  one  in  addition  exhibited  pneu- 
mothorax.    Microscopic  examination  confirmed  the  diagnosis. 

Somewhat  later  Dr.  Petit  had  in  his  laboratory  a  female  cat  which 
greedily  devoured  the  sputum  of  phthisical  patients.  All  refuse  of  this 
kind  was  for  experimental  reasons  given  to  it. 

The  animal  soon  grew  thin,  its  coat  stared,  its  eyes  were  bleared,  it 
had  a  muco-purulent  discharge  from  the  nose,  violent  sneezing,  and 
sometimes  cough  followed  by  vomiting.  It  crawled  with  difficulty, 
and  appeared  in  the  last  stages  of  some  chronic  grave  disease.  Koch's 
bacillus  was  frequentl}-  detected  in  the  discharges. 

The  animal  was  kept  under  close  observation,  and  Dr.  Petit  was 
therefore  greatly  surprised  when,  two  and  a  half  months  later,  about 
the  time  of  its  becoming  pregnant,  the  symptoms  rapidly  abated,  and 
the  animal  seemed  in  a  fair  way  to  recovery.  It  still  ate  the  sputum 
greedily.  Somewhat  later  it  bore  seven  well-developed  kittens,  one  of 
which  it  suckled  for  five  months.  A  slight  dry,  hacking  cough  per- 
sisted.    Six  months  after  deliver}-  it  was  killed. 

Autopsy. — The  lower  parts  of  both  lungs  were  somewhat  congested  ; 
a  very  frothy  muco-sanguinolent  liquid  escaped  from  the  bronchioles 
on  section.  In  the  lower  part  of  the  right  lobe  was  a  collection  of 
small,  hard  cretaceous  masses,  which  on  manipulation  produced  a 
feehng  like  that  of  rubbing  sand-paper.  These  little  points  were 
greyish  and  surrounded  b}'  a  zone  of  paler  colour  than  neighbouring 
parts.  The  apices  of  the  lungs  and  the  pleura  were  free  of  lesions,  as 
were  the  visceral  organs.  Microscopic  examination  revealed  the  pre- 
sence of  Koch's  bacilli. 

Note. — Coincident  with  the  onset  of  pregnancy  the  cat  had  begun  to 
recover,  and  some  time  before  being  killed  was  practically  cured. 

Drs.  Filbau  and  Petit's  case,  Joitrn.  Comp.  Path,  and  Therap.,  1888,  p.  60  ;  cf.  Joiirn.  de 
Med.  de  Paris,  January,  18SS. 

TRANSMISSION  OF  TUBERCULOSIS  FROM  MAN  TO  THE  PAROQUET. 

177.  A  green  paroquet,  belonging  to  M.  A — ,  living  at  No.  9,  Rue 
des  Deux  Fonts,  Paris.  Had  been  bought  eight  years  before  by  M.  A — , 
and  kept  in  the  suite  of  rooms  occupied  by  him  and  his  family.     It  had 


476 


CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 


seemed  in  good  health  until  the  end  of  December,  1894.  At  that  time 
a  small,  greyish,  firm,  scaly  swelling  appeared  on  the  right  cheek,  and 
gradually  increased  in  size  and  prominence. 

On  the  ist  January  this  tumour  had  been  removed  by  a  veterinary 
surgeon,  who  had  not  suspected  its  true  nature.  A  fortnight  later  it 
had  grown  as  large  as  before.  The  bird  was  brought  here  on  the  19th 
January. 

On  the  right  side  of  the  face,  immediately  behind  the  beak,  was  a 
horny,  conical,  greyish  vegetation,  slightly  incurved  towards  its  upper 
extremity,  and  of  scaly  appearance — a  vegetation  the  appearance  of 
which  at  once  awakened  suspicion  of  tuberculosis.  It  adhered  only 
slightly  to  the  skin,  and  was  removed  with  forceps.     The  base  appeared 

finely  granular.     Microscopical  exa- 
_-  -^=^^--.j=s.,.  mination  of  a  scraping  from  this  sur- 

^5?:  face  revealed  numerous  bacilli. 

On  being  questioned  M.  A — 
stated  that  during  the  course  of  1894 
he  had  contracted  "bronchitis;" 
had  coughed  and  expectorated  a 
great  deal  from  the  month  of  Au- 
gust to  that  of  December,  1894 ; 
that  he  had  improved  at  that  time, 
but  that  the  disease  had  returned, 
and  that  in  spite  of  various  treat- 
ment he  felt  weak  and  oppressed. 
He  was  asked  to  expectorate  into  a 
glass,  and  with  the  purulent  ma- 
terial contained  in  the  expectorate 
two  cover-glass  preparations  were 
made  and  stained  by  Ehrlich's  me- 
thod. Bacilli  were  found  in  large  numbers.  M.  A —  was  exceedingly 
fond  of  this  paroquet,  which  was  very  tame  and  affectionate.  He  liked 
to  fondle  it  about  the  head  and  face  with  his  lips,  and  in  addition  to 
feeding  it  daily  by  hand,  sometimes  fed  it  with  masticated  food. 

We  also  learned  that  the  paroquet  was  in  the  habit  of  rubbing  its 
head  against  neighbouring  objects,  especially  its  master's  hands  and 
face. 

.  Treatment. — Excision  of  the  tumour,  curettage  and  cauterisation  of 
the  diseased  skin. 

M.  A —  brought  this  paroquet  back  on  the  12th  February,  1895. 
The  horny  growth  had  again  appeared.  Between  it  and  the  eye 
another  small  swelling  had  developed.  The  same  treatment  was  used 
as  on  the  19th  January. 

On  the  2nd  March  the  bird  was  again  brought.  Both  swellings 
had  again  commenced  to  grow,  and  a  third  had  appeared  between  the 
second  and  the  upper  part  of  the  beak. 

On  the  i6th  April  the  paroquet  was  brought  here  a  third  time  with 
three  small  horny  growths  (Fig.  62).  A  little  later  M.  A —  died.  We 
did  not  afterwards  see  the  bird. 

To  sum  up  :  this  paroquet  had  been  bought  by  M.  A —  eight  months 


Fig.  62. — Paroquet  with  cutaneous 
tuberculous  growths. 


BOTHRYOMYCOSIS. 


477 


before,  and  had  remained  in  excellent  health  until  December,  1894. 
In  April,  1894,  M.  A —  coughed  and  expectorated.  He  suffered  from 
"bronchitis  ;  "  in  reality  he  was  tuberculous.  In  December,  1894,  the 
paroquet  showed  a  tuberculous  lesion  on  the  face.  Now  it  was  the 
only  bird  kept  in  the  rooms,  and  had  never  been  in  contact  with  any 
other  bird  whatever.  Its  food  consisted  only  of  seeds,  coffee  and  milk, 
boiled  milk,  or  food  masticated  by  its  owner.    The  inference  is  obvious. 

BOTHRYOMYCOSIS. 

178.  A  five-year-old  gelding,  left  for  examination  on  the  8th 
November,  1897.  Was  suffering  from  sinuses  in  the  inguinal  region 
following  castration.     Operation  had  been  performed  in  April,  seven 


^-"X 


Fig.  ^2- — Bothryomycotic  swelling  of  the  shoulder. 

months  before.  A  fortnight  afterwards  the  animal  returned  to  work. 
The  wound  in  the  left  inguinal  region  refused  to  heal,  and  suppurated 
freely  until  the  commencement  of  July.  It  had  been  treated  by  injec- 
tions of  carbolic  solution. 

State  on  Examination. — The  left  inguinal  region  showed  a  circum- 
scribed, sharply  defined,  hard,  slightly  painful  swelling,  traversed  by 


478  CLINICAL   VETERINARY    MEDICINE    AND    SURGERY. 

three  sinuses,  one  of  which  opened  at  the  base  of  the  depression  result- 
ing from  the  operation  wound.  On  direct  manipulation  the  cord  was 
found  to  be  enlarged  and  indurated,  forming  a  pear-shaped  swelling, 
flattened  below,  where  it  was  adherent  to  the  envelopes,  and  contracted 
above,  where  it  could  be  followed  as  high  as  the  lower  inguinal  ring. 
On  rectal  exploration  the  intra-abdominal  portion  of  the  cord  was 
found  to  be  normal.  Pus  collected  from  the  sinuous  openings  was 
greyish  in  colour,  fairly  consistent,  and  contained  small  yellowish- 
white  granules,  which,  on  microscopical  examination,  were  seen  to  be 
formed  by  bothryomyces. 

Treatment. — From  the  8th  to  the  20th  November,  and  from  the 
25th  November  to  the  loth  December,  this  horse  received  a  daily  dose 
of  two  and  a  half  to  four  drachms  of  potassium  iodide  in  its  drinking- 
water.  Each  day  the  swelling  was  swabbed  with  iodine  solution,  and 
the  sinuses  injected  with  tincture  of  iodine.  There  was  no  improve- 
ment. 

On  the  loth  December  the  tumour  was  removed,  the  cord  being  cut 
through  with  the  ecraseur.     No  dressing  was  applied. 

During  the  following  days  the  wound  was  cleansed  night  and 
morning  with  warm  creolin  solution.  It  healed  rapidly  and  uninter- 
ruptedly.    The  animal  returned  to  work  at  the  end  of  three  weeks. 

179.  An  eight-year-old  gelding,  left  in  hospital  the  27th  September, 
i8g8.  Affected  with  swellings  in  different  regions,  the  largest  opposite 
the  base  of  the  neck.  The  disease  had  been  in  existence  for  nearly  a 
year. 

Swelling  had  first  appeared  in  front  of  the  left  shoulder,  and  had 
been  followed  by  further  growths.  As  the  swelling  on  the  shoulder 
became  so  large  as  to  prevent  the  animal  being  worked,  it  was  sent  to 
Alfort  for  operation. 

State  on  Entry. — On  the  sides  of  the  thorax  and  neck  were  small 
nodules  varying  in  size  between  a  nut  and  a  small  egg,  almost  all 
pierced  with  sinuous  tracts  discharging  pus,  in  which  bothryomyces 
were  found  on  microscopical  examination.  The  largest  was  situated 
over  the  jugular  furrow.  It  measured  ten  inches  in  a  vertical  and  six 
inches  in  a  horizontal  direction,  and  was  formed  of  firm,  resistent 
tissue.  Its  upper  part  was  only  slightly  adherent  to  subjacent  tissues  ; 
but  its  lower  penetrated  more  deeply,  and  had  become  intimately 
adherent  to  the  deep-seated  tissues  as  well  as  to  the  skin.  The  swell- 
ing showed  elevations  and  depressions,  and  was  penetrated  by  several 
sinuous  openings  discharging  pus,  in  which  numerous  little  bothryo- 
mycotic  granulations  could  be  detected. 

Treatment. — Before  resorting  to  operation  two  and  a  half  drachms 
of  potassium  iodide  were  given  daily  in  the  drinking-water,  while  the 
swelling  was  swabbed  and  the  sinuses  injected  with  tincture  of  iodine. 
This  treatment  was  continued  until  the  13th  October  without  the 
slightest  success.  The  owner  saw  the  horse  on  that  date,  and  asked 
us  to  operate. 

Next  day  the  horse  was  cast  on  the  straw  bed.  The  parts  having 
been  prepared  and  disinfected  the  growth  was  excised. 


KOTHRYOMYCOSIS. 


479 


The  upper  part,  which  was  easy  to  separate  from  adjacent  tissues, 
was  first  removed  ;  the  lower,  which  extended  more  deeply  and  sur- 
rounded the  jugular  and  carotid,  could  not  be  entirely  ablated. 
Operation  was  attended  by  considerable  haemorrhage,  which  was  con- 
trolled by  forceps.  The  portion  of  the  tumour  surrounding  the  vessels 
was  left  in  position.  After  inserting  a  drainage-tube  the  lips  of  the 
wound  were  brought  together  by  a  few  deep  and  several  superficial 
sutures,  and  the  parts  were  covered  with  a  cotton-wool  dressing. 

In  spite  of  precautions  taken  to  prevent  the  animal  rubbing,  it  soon 
displaced   the    dressing   and   tore 

out   most  of  the  sutures.     Being  ^^ 

very  irritable,  we  were  obliged  to 
leave  the  wound  open  and  treat  it 
antiseptically.  Nevertheless  the 
animal  was  able  to  leave  hospital 
on  the  20th,  the  final  result  of 
operation  having  been  highly 
satisfactory. 

Remark. — The  administration 
of  potassium  iodide  in  the  treat- 
ment of  bothryomycosis  is  of  slight 
value.  I  have  used  it  in  twenty- 
four  cases  (horses),  sixteen  suffer- 
ing from  scirrhous  cord,  and  eight 
from  bothryomycotic  growths  in 
different  regions  : — one  in  front  of 
the  chest ;  two  on  the  neck  ;  one 
on  the  tail ;  one  on  the  side  of 
the  chest  ;  one  on  the  hock  ;  and 
two  on  the  fetlock.  The  average 
duration  of  treatment  was  three 
weeks,  and  the  average  dose  of 
potassium  iodide  from  six  to  eight 
ounces.  In  certain  of  these  pa- 
tients the  treatment  was  only  con- 
tinued for  a  fortnight  ;  in  others 
it  was  prolonged,  with  intervals, 
for  six  weeks,  two  months,  and 
even  longer.  In  1897  I  treated  a 
horse  with  bothryomycosis  of  the 
hock  (Fig.  64)  for  more  than  four 
months,  giving  during  that  time 
more  than  twenty  ounces  of  po- 
tassium iodide  without  producing 
any  appreciable  result. 

In  three  animals  with  recent 
scirrhous  cord  the  swelling  diminished  with  considerable  rapidity,  and 
finally  disappeared  ;  but  all  practitioners  know  that   cases  of  recent 
inflammation  of  the  cord  often  recover  with  ordinary  local  antiseptic 
treatment.     In  a  horse  with  a  bothryomycotic  patch  on  the  wall  of  the 


Fig.  64. — Bothryomycosis  of  the  hock. 


480  CLINICAL    VETERINARY    MEDICINE   AND    SURGERY. 

chest  swelling  notably  diminished  at  the  end  of  a  month,  when  the 
animal  returned  to  work,  but  as  treatment  was  afterwards  neglected  the 
swelling  became  as  large  as  at  first.  In  twenty  other  patients  adminis- 
tration of  potassium  iodide  appeared  without  action,  or  produced  only 
trifling  effects,  quite  unsatisfactory  from  a  practical  point  of  view.  All 
the  well-developed  or  old-standing  cases  of  scirrhous  cord  had  finally 
to  undergo  operation. 

These  results,  and  the  cases  published  by  Frohner,  confirm  what  I 
have  already  stated  concerning  bothryomycosis,  viz.  that  radical 
operation  should  be  preferred  whenever  possible. 

PNEUMONIA. 

180.  A  six-year-old  mare  entered  hospital  February  28th,  1898. 
At  the  beginning  of  February  the  off  fore-coronet  had  been  injured, 
and  the  animal  had  been  treated  for  a  week  in  a  veterinary  infirmary. 
During  the  two  days  previous  to  entry  it  had  appeared  stiff,  had 
coughed,  and  only  eaten  a  part  of  its  food. 

State  on  Entry. — The  animal  was  depressed,  carried  the  head  low 
or  rested  it  on  the  manger.  The  conjunctiva  was  dull  yellow  ;  the 
mouth  hot  and  dry;  the  appetite  in  abeyance  ;  temperature  40*6°  C. ; 
respiration  18;  pulse  61.  Respiration  was  interrupted,  and  at  times 
accompanied  by  groaning.  The  pulse  was  small.  On  auscultation  a 
strong  vesicular  murmur  could  be  heard  over  the  entire  area  of  both 
pulmonary  lobes. 

Treatment. — Mustard  applications  to  the  chest  ;  three  and  a  half 
ounces  of  sodium  bicarbonate  in  the  drinking-water. 

On  the  ist  March  the  general  condition  was  little  changed. 
Temperature  41*2°  C.  ;  respiration  21  ;  pulse  58.  Appetite  moderate; 
cough  deep  and  somewhat  strong  ;  mucous  discharge  from  the  nostrils. 
The  lower  part  of  the  left  lung  showed  some  dulness  on  percussion. 
On  auscultation  the  vesicular  murmur  was  lessened  in  the  lower,  and 
increased  in  the  upper  regions.  Nothing  abnormal  could  be  detected 
in  the  right  lung.  In  the  evening  the  lower  part  of  the  left  side 
of  the  thorax  was  dull.  On  auscultation  the  vesicular  murmur  was 
inaudible. 

On  the  morning  of  the  2nd,  temperature  40°  C. ;  respiration  30 ; 
pulse  80.  The  zone  of  dulness  had  increased,  extending  to  the  middle 
line  of  the  chest ;  the  lower  chest  region  was  silent  on  auscultation  ; 
towards  the  upper  part  a  slight  tubal  murmur  could  be  heard.  The 
heart-beats  were  feeble,  irregular,  and  intermittent,  the  first  sound 
double.  Five  fluid  ounces  of  serum  from  an  animal  which  had 
recently  recovered  from  pneumonia  were  subcutaneously  injected. 

On  the  3rd  June  the  condition  was  improved.  The  animal  was 
brighter  and  ate  all  its  food.  Temperature  40'4°  C.  ;  respiration  24 ; 
pulse  yz.  The  respiration  was  less  painful,  the  dulness  stationary, 
and  the  tubal  murmur  more  clearly  defined.  The  heart-beats  were 
more  regular.  Urine  was  abundantly  passed,  and  the  bowels  were 
freely  open.     Five  fluid  ounces  of  serum  were  injected. 

On  the  4th  the  general   condition  was  stationary.      Temperature 


HOUSX 
man 
laui) 
Jer9« 

be 

-^ 
HO- 


PNEUMONIA. 


"h  38"g°  C;  respfration  26;  pulse  54.  The  zone  of  dulness  extended 
over  two  thirds  of  the  lower  chest  region.  The  pulse  was  strong  and 
[  large.  The  urine  contained  no  albumen.  Five  ounces  of  serum 
were  again  injected. 

On  the  5th  there  was  marked  improvement ;  the  animal  showed 
less  depression,  and  appetite  was  good.  Temperature  38'5°  C. ;  re- 
spiration 24 ;  pulse  58.  At  the  uppper  part  of  the  hepatised  zone 
dulness  was  less  marked,  and  was  replaced  by  a  moist  crepitant  rale. 
Five  fluid  ounces  of  serum  were  injected. 

On  the  7th  the  temperature  was  38°  C.  The  crepitant  rale  peculiar 
to  resolution  was  heard  over  all  the  lower  part  of  the  left  lung.  The 
cough  was  soft,  and  a  serous  discharge  ran  from  the  nose.  The 
injections  of  serum  were  stopped. 

During  the  next  two  days  the  last  unfavourable  symptoms  dis- 
appeared. On  the  loth  the  vesicular  murmur  extended  over  the  entire 
area  of  the  lung. 

Remark. — In  the  horse  and  in  a  certain  number  of  other  patients 
suffering  from  pneumonia  I  have  during  the  past  three  years  employed 
serum  obtained  from  animals  recently  recovered  from  pneumonia,  and 
usually  with  good  effect.  In  doses  of  3  to  6  fluid  ounces  per  day  it 
forms  a  useful  addition  to  the  classic  treatment. 

181.  A  six-year-old  entire  horse  from  a  stable  in  which  several 
horses  had  died  from  contagious  pneumonia,  entered  hospital 
December  igth,  i8g8. 

On  the  17th  December  this  horse  had  only  eaten  part  of  its 
morning  feed.  During  the  next  two  days  appetite  was  in  abeyance, 
and  breathing  became  more  rapid.  Was  left  in  hospital  on  the 
evening  of  the  igth. 

State  on  Examination. — The  patient  had  scarcely  entered  its  stall 
before  it  began  to  feed.  It  was  relatively  little  depressed.  The 
mucous  membranes  were  greatly  swollen  and  infiltrated  ;  the  respira- 
tion was  rapid  (25  per  minute)  ;  expiration  was  double.  The  pulse 
was  60,  feeble  and  thready.  The  cough  produced  by  pressing  on  the 
larynx  was  strong,  deep,  and  repeated.  Nothing  could  be  discovered 
on  percussion  of  the  thorax.  On  auscultating  the  middle  portion  of 
both  pulmonary  lobes  mucous  rales  were  heard.  The  vesicular 
murmur  w^as  diminished  in  the  lower  portion  of  the  left  lobe,  but  exag- 
gerated throughout  the  rest  of  this  lobe  and  the  whole  of  the  right. 

Treatment.  -Mustard  apphcations  to  the  lower  part  of  the  thorax; 
6  fluid  ounces  of  alcohol  and  4  ounces  of  sodium  sulphate  in  the 
drinking-water. 

On  the  20th  the  general  condition  remained  unchanged  ;  appetite 
was  fair.  On  auscultation  and  percussion  the  physical  signs  were_  as 
before.  Respirations  25,  pulse  65,  temperature  ^o-g°  C.  In  addition 
to  the  foregoing  medicine  5  drachms  of  hydrobromate  of  quinine  were 
given  in  two  doses. 

On  the  2ist  the  general  condition  was  stationary.  Respirations  28, 
pulse  72,  temperature  40*5°  C.  In  order  to  estimate  the  antithermic 
action  of'quinine,  the  animal's  temperature  was  taken  each  hour  during 

H  H 


4^2 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


the  day.  Administration  of  the  first  dose  of  quinine  was  followed  by  a 
depression  of  temperature,  which  reached  its  maximum  (i"4°  C.)  at  the 
end  of  an  hour.     Two  hours  later  the  temperature  had  risen  to  its 


39? 

■^ 

— 

' 

< 



; 

— 

— 

— 

— 

~ 

y 

N 

■*-= 

^ 

/ 

\ 

/ 

's 

r^ 

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— 

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/ 

\ 

/ 

1 

/ 

8 

h 

9 

h 

10 

h 

12 

h 

1 

h 

3 

u 

t 

t 

Chart   I. — The  dark  vertical  lines  indicate  the  time  at  which  quinine  was  given. 

former  point.  After  administration  of  the  second  dose  the  temperature 
fell  six  tenths  of  a  degree  C.  in  two  hours  ;  but  two  hours  later  it  had 
returned  to  40*2°  C,  only  two  tenths  below  the  first  reading  (Chart  i). 
On  the  22nd  the  animal's  state  was  little  changed.  Respirations 
28,  pulse  68,  temperature  40*5°  C.  A  little  rusty  discharge  from  both 
nostrils  and  some  crepitant  rales  on  auscultation.  The  first  dose  of 
quinine  again  lowered  the  temperature  eight  tenths  of  a  degree  in  two 


«? 

kO? 

39' 

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... 

^ 

I 

, 

^ 

\ 

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J 

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m 

b. 

u 

h 

12 

h. 

1 

u 

2 

h 

3 

h. 

T  1  ^ 

LJ 

6 

ii 

^ 

Chart  II. 


hours  ;  but  the  curve  afterwards  rose,  returning  in  two  hours  to  its 
former  height  (40*5°  C).  The  second  dose  was  followed  an  hour  after 
administration  by  a  rise  of  two  tenths  of  a  degree  ;  three  hours  later 


PNEUMONIA.  483 

the  temperature  fell  to  39'6°  C.  (depression  of  nine  tenths  of  a  degree). 
Six  hours  afterwards  it  had  returned  to  40"3°  C.  (Chart  2). 

On  the  23rd  the  patient  was  again  dull,  hung  back  from  the  manger, 
and  left  part  of  its  food.  Respirations  28,  pulse  6g,  temperature  40*7° 
C.  Dulness  and  tubal  murmur  in  the  lower  part  of  the  left  lung. 
During  the  day  the  animal  took  five  quarts  of  milk.  The  first  dose  of 
quinine  produced  a  depression  of  five  tenths  of  a  degree  in  two  hours, 


39° 

i 

V, 

_ 

^ 

\ 

^ 

"^ 

\ 

/ 

8 

h 

9 

h 

10 

K 

11 

h 

12 

h 

1 

h     1    2 

h 

3 

h 

k 

h 

5 

h 

6 

t 

7^ 

Chart  III. 

but  less  than  two  hours  afterwards  the  temperature  had  returned  to  its 
former  point.  The  effect  of  the  second  dose  was  less  marked.  The 
temperature  fell  one  tenth  at  the  end  of  an  hour,  but  one  hour  later  it 
again  rose  (Chart  3). 

On  the  24th  the  general  condition  was  more  satisfactory.  The 
animal  ate  well,  and  drank  milk  greedily.  Respirations  28,  pulse  70, 
temperature  40-5°  C.  The  cHnical  signs  obtained  by  percussion  and 
auscultation  were  similar  to  those  noted  on  the  previous  evening.     In 


40? 
39" 

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_ 

__ 

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s 

^ 

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a 

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Chart  IV. 


the  morning  the  quinine  produced  a  depression  of  seven  tenths  of  a 
degree  two  hours  after  administration,  followed  by  a  rise  ;  in  the 
evening  a  depression  of  five  tenths  in  two  hours,  succeeded  by  a  return 
to  the  previous  height  at  the  third  hour  (Chart  4). 

On   the  25th  the   general  condition  was  good.     Respirations   29, 
pulse  68,  temperature  40-2"  C.     Marked  tubal  murmur.     The  heart- 


484 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


beats  were  unequal  and  the  pulse  feeble.  Quinine  was  discontinued, 
and  i^  drachms  of  digitalis  given  in  electuary. 

On  the  26th  the  general  state  was  similar  to  that  of  the  previous 
evening.  The  temperature  began  to  fall.  Respirations  26,  pulse  72, 
temperature  39*7°  C.  The  heart's  action  was  more  regular,  the  pulse 
larger  and  stronger. 

On  the  27th  the  general  condition  was  still  better  than  on  the 
preceding  days.  Respirations  24,  pulse  60,  temperature  38'^°  C.  The 
murmur  remained  ;  dulness  was  stationary. 

On  the  28th  the  general  condition  was  excellent.  Respirations  20, 
pulse  52,  temperature  38'2°  C.  The  cough  had  become  easier  and 
more  frequent.  There  was  some  dulness  on  percussion,  and  the  crepi- 
tant rale  peculiar  to  resolution  had  returned. 

During  the  following  days  the  last  troubles  disappeared.  The 
animal  left  hospital  entirely  cured  on  the  7th  January. 

182.  A  twelve-year-old  entire  horse,  entered  hospital  January  26th, 
1899.  Had  come  from  a  stable  in  which  contagious  pneumonia  was 
rife,  four  animals  having  been  affected  and  two  having  died.  On  the 
evening  of  the  25th,  after  a  hard  day's  work,  this  animal  had  refused 
its  food,  breathing  had  become  rapid,  and  the  animal  had  shown  slight 
shivering  fits.     Brought  to  the  College  next  day. 

State  on  Examination. — The  animal  was  depressed,  and  took  no 
notice  of  what  passed  around  it.     The  gait  was  careless,  the  limbs 


39" 

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\ 

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s 

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/ 

y 

\ 

> 

/ 

1 

< 

/ 

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/ 

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\ 

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k 

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k 

2 

hi 

3 

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k 

5 

L 

6 

u 

Chart  V. 


dragged  along  the  ground.  The  skin  was  warm,  the  conjunctiva 
injected,  the  pulse  70,  feeble  and  soft,  the  respirations  20,  and  the  tem- 
perature 40°  C.  Pressure  on  the  larynx  produced  a  deep  cough  ;  a  little 
brownish  discharge  ran  from  the  nostrils.  On  percussion  the  thorax 
was  normally  resonant.  Auscultation  detected  exaggerated  vesicular 
murmur  throughout  the  depth  of  both  pulmonary  lobes. 

Treatment. — Mustard  applications  to  the  lower  portion  of  the  chest  ; 
internal  administration  of  3.3  ounces  of  sodium  bicarbonate,  5  drachms 
sulphate  of  quinine  in  two  doses,  and  35-  fluid  ounces  of  alcohol. 

At  II  a.m.  on  the  26th  January  the  temperature  was  40°  C.     Two 


PNEUMONIA. 


485 


and  a  half  drachms  of  quinine  sulphate  were  given  in  electuary.  At  11.30 
the  temperature  was  40*3°  C,  at  midday  40*5°  C,  at  i  o  clock  40*8°  C, 
at  2  o'clock  40'3°  C.  In  three  hours  the  temperature  had  risen  i'2°  C. 
Concurrently  with  this  rise  in  temperature  excitement  had  been  shown 
during  the  first  two  hours.  There  was  anxiety,  trembling,  marked 
acceleration  of  breathing,  and  excessive  dilatation  of  the  nostrils. 
After  the  first  two  hours  the  temperature  gradually  decreased.  At  3 
o'clock  it  became  40*9°  C.  The  second  dose  of  electuary  was  given. 
During  the  following  hour  the  temperature  continued  to  fall.  At  3.30 
it  was  40*5°  C,  at  4  p.m.  39*6°  C.  From  4  p.m.  until  6  p.m.  it  rose 
three  tenths  of  a  degree  (Chart  5). 

Next  day  the  general  condition  was  stationary,  the  disease  taking 
its  usual  course.  Temperature  39*9°  C. ;  respiration  18;  pulse  60. 
The  pulse  was  small;  the  conjunctiva  remained  injected.  On  aus- 
cultation the  respiratory  murmur  was  markedly  diminished  in  the 
lower  part  of  the  right  lung,  which  was  also  dull  on  percussion.  Over 
the  upper  part  of  this  lobe,  and  the  whole  of  the  left  lung,  the  vesi- 


1 

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/ 

V 

V 

1 

A 

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\ 

; 

^ 

V 

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/ 

1 

f 

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1 

39° 

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a 

b. 

ii 

h 

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h 

J^2. 

b 

K 

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h 

Li 

w 

1 

Chart  VI. 


cular  murmur  was  exaggerated.  The  cough  was  rough,  deep,  and 
sometimes  paroxysmal.  An  abundant  rust-coloured  discharge  ran 
from  both  nostrils. 

As  on  the  previous  days  the  animal  received  three  and  a  half  ounces 
of  sodium  bicarbonate  and  five  drachms  of  quinine  sulphate  in  two 
doses.  The  temperature  curve  on  that  day  closely  resembled  the  first. 
The  first  dose  of  quinine  was  followed  by  a  rise  in  temperature  of 
i'3°  C.  in  four  hours.  At  three  o'clock  the  temperature  was  40*6°  C. 
A  second  dose  of  quinine  sulphate  was  given.  An  hour  later  the 
temperature  fell  to  39*8°  C,  but  the  depression  was  not  maintained,  for 
at  seven  p.m.  the  temperature  marked  40*4"  C.  (Chart  6).  The  excite- 
ment, rigors,  and  trembling  fits  noted  on  the  previous  day  were  re- 
peated. 

On  the  28th  the  morning  temperature  was  40*6°  C,  the  pulse  80, 
and  the  respirations  25.  The  pulse  was  feeble,  respiration  painful, 
and  expiration  double.  The  cough  still  remained  frequent  and  paroxys- 
mal, and  the   rust-coloured  discharge  was  somewhat  free.     Percussion 


486 


CLINICAL   VETERINARY    MEDICINE    AND    SURGERY. 


revealed  a  zone  of  dulness  in  the  lower  half  of  the  right  lung.  At  this 
level  a  moist  crepitant  rale  was  heard.  The  heart's  action  was  some- 
what weak,  and  both  sounds  were  diminished. 

The  patient  took  milk  and  gruel,  but  hardly  touched  oats  or  hay. 
Treatment  was  modified  by  giving  three  subcutaneous  injections  of  80 
minims  of  ether,  and  i  drachm  of  digitalis,  and  applying  mustard 
plasters  to  both  legs.  The  dose  of  quinine  sulphate  was  reduced  to 
i^  drachms.  The  temperature  at  9  a.m.  was  40*4°  C. ;  at  10,  40*5°  C.  ; 
and  at  11,  40*6°  C.  One  and  a  quarter  drachms  of  quinine  were 
then  given.  At  11.30  the  temperature  was  40"o°  C,  at  midday 
39*8°  C.,  at  I  p.m.  39*5°  C.  ;  at  2,  393°  C.  There  was  no  excitement. 
At  3  p.m.  the  temperature  was  39'8°  C.  One  and  a  quarter  drachms 
of  quinine  were  then  given.  At  3.30  p.m.  the  temperature  was 
39*1°  C.  ;  at  4,  39*2°  C.  During  the  next  hour  the  temperature  rose 
sharply.  At  5  p.m.  it  was  40*3°  C.  ;  at  6,  40*7°  C.  ;  and  at  7  p.m. 
40-2°  C.  (Chart  7). 

On  the  2gth  the  patient  was  greatly  depressed.  The  fore-limbs 
were  abducted,  the  head  held  low  and  rested  on  the  manger.  The 
animal  took  ten  quarts  of  milk,  but  refused  other  food.      Temperature 


41? 

39° 

■~ 

) 

V 

_^ 

—' 

" 

\, 

/ 

/ 

S 

\ 

/ 

N 

^ 

\ 

, 

\ 

/ 

^ 

s 

s 

/ 

\ 

N 

/ 

\ 

<^ 

_2 

K 

^ 

k 

_u 

^ 

A 

ii 

_1 

h 

_2 

h 

3 

^.% 

Ii 

h 

5 

h 

S 

L 

2 

i 

Chart  VII. 


40*2°  C. ;  respiration  30  ;  pulse  very  rapid,  and  perceptible  with  diffi- 
culty. Dyspnoea  was  intense,  and  expiration  jerky.  On  the  right 
side  dulness  was  complete  over  more  than  half  the  chest.  On  aus- 
cultation a  strong  tubal  murmur  could  be  heard. 

Treatment. — Bicarbonate  of  soda,  sulphate  of  quinine,  digitalis,  in- 
jections of  ether.  After  the  second  dose  of  quinine  the  temperature 
fell  I  degree. 

On  the  30th  the  general  condition  was  better  than  on  the  previous 
evening.  The  temperature  varied  between  39*3°  and  40°  C. ;  the 
respiration  continued  rapid  and  irregular ;  the  pulmonary  dulness  and 
murmur  showed  no  change.  Treatment  was  continued  as  before. 
After  the  first  dose  of  quinine  a  slight  rise  in  temperature  occurred. 
After  the  second  the  temperature  fell  i'3°  C.  in  an  hour,  after  which  it 
gradually  rose  again. 

On  the  31st  the  improvement  noted  on  the  previous  evening  became 
more  marked.  Morning  temperature  39'5°  C;  respiration  21; 
pulse   63.     The   zone    of  dulness    had    diminished.     On  auscultation 


PNEUMONIA.  487 

the  tubal  murmur  was  still  heard.     The  pulse  became  stronger ;  the 
patient  was  brighter  than  on  the  previous  days,  and  ate  a  little  hay. 

On  the  ist  February  the  condition  remained  stationary.  Morning 
temperature  397°  C. ;  respiration  20°.  The  dulness  and  bronchial 
murmur  remained.     There  were  signs  of  cardiac  weakness. 

On  the  2nd  the  patient  appeared  greatly  depressed.  It  was  feeble 
and  tottered  on  its  legs,  so  that  it  had  to  lean  for  support  against  the 
side  of  the  stall.  Temperature  39'2°  C. ;  respiration  ^^  ;  pulse 
very  rapid  and  small.  Dulness  was  limited  to  the  lower  third  of  the 
chest ;  the  tubal  murmur  was  weaker.  The  animal  refused  all  food, 
including  even  milk.      During  the  night  it  lay  down  on  its  side. 

Next  day  it  was  found  standing  up  eating  some  hay.  It  showed  a 
little  opposition  when  we  attempted  to  auscultate  the  chest.  The  zone 
of  dulness  was  limited  to  the  lower  half  of  the  right  lung ;  above  this 
the  crepitant  rale  peculiar  to  resolution  could  be  detected.  Tempe- 
rature 38*7°  C.  ;  respiration  15  :  pulse  80. 

On  the  4th  the  temperature  was  38*2^  C,  respiration  12,  and  pulse 
64  ;  the  pulse  still  remained  feeble.  The  animal  received  three  injec- 
tions of  eighty  minims  of  ether  and  one  drachm  of  digitalis  in  electuar}^ 

On  the  5th  and  6th  the  temperature  and  respiration  became  normal ; 
the  pulse  was  still  60,  but  fairly  good. 

The  last  symptoms  disappeared  during  the  following  days.  On  the 
nth  February  the  animal  had  recovered. 

183.  A  six-year-old  entire  horse  entered  hospital  March  loth,  i8gg, 
after  an  illness  of  two  days.  Had  come  from  a  stable  in  which 
contagious  pneumonia  existed. 

State  on  Examination. — The  animal  was  depressed,  showed  rigors, 
and  hung  back  from  the  manger.  The  mouth  was  hot,  the  skin  cold, 
and  the  mucous  membranes  markedly  injected.  Respiration  24  ; 
puise  75  ;  temperature  40*5°  C.  The  cough  was  strong  and  dry.  There 
was  little  discharge.  Pressure  over  the  intercostal  spaces  caused  pain. 
Respiration  was  irregular,  expiration  being  slow  and  double.  The 
lower  quarter  of  the  right  lung  was  partially  dull  on  percussion,  but  on 
auscultation  the  vesicular  murmur  was  found  to  have  disappeared  ; 
during  expiration  a  few  moist  crepitant  rales  could  be  heard.  In  the 
upper  part  of  the  right,  and  over  the  entire  area  of  the  left  lung  the 
vesicular  murmur  was  exaggerated.  The  pulse  was  feeble  ;  the  heart- 
sounds  were  strong  and  rhythmical,  but  at  varying  intervals  a  pause, 
equal  in  duration  to  a  complete  heart  cycle,  was  noted. 

Treatment. — ^Mustard  applications  to  the  chest  ;  sulphate  and  bicar- 
bonate of  soda ;  alcohol.  The  mustard  plaster  produced  a  large 
swelling  within  four  hours  of  application.  The  rectal  temperature  was 
39-8°  C.  Appetite  was  preserved  ;  the  patient  took  several  quantities 
of  gruel  and  8  quarts  of  milk.  There  was  no  noteworthy  change 
during  the  evening.     Temperature  40*3°  C. 

On  the  nth  the  animal  was  more  depressed  than  on  the  previous 
evening.  The  conjuctiva  was  deep  yellow.  Respiration  22  ;  pulse  76  ; 
temperature  40-1°  C.  Inspiration  was  short,  expiration  prolonged  and 
double.     The  lower  part  of  the  right  lung  was  dull,  and  on  ausculta- 


4o8  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

tion  silent.  Above  the  dull  zone  the  crepitant  rale  was  more  marked 
than  on  the  previous  evening.  The  pulse  was  scarcely  perceptible 
though  the  heart-sounds  were  strong.  Four  drachms  of  quinine  sulphate 
in  two  doses  was  added  to  the  treatment.  The  first  dose  produced  a 
depression  of  one  degree  in  temperature  at  the  third  hour,  but  two 
hours  later  the  temperature  had  returned  to  its  former  point.  In  the 
evening  the  quinine  produced  a  similar  result.  The  rectal  temperature 
did  not  rise  beyond  40°  C. 

On  the  1 2th  the  general  condition  remained  stationary.  Respira- 
tion 26;  pulse  72  ;  temperature  3g'9°  C.  A  slight  cough  occasionally 
occurred.  All  the  lower  part  of  the  right  lung  up  to  the  level  of  the 
point  of  the  elbow  had  become  dull.  Above  this,  crepitation  was 
audible  both  during  inspiration  and  expiration,  but  most  markedly 
during  inspiration.  In  the  upper  part  of  this  lobe  and  throughout  the 
left  lung  the  vesicular  murmur  was  exaggerated.  The  character  and 
rhythm  of  the  heart-sounds  were  modified ;  the  first  sound  was  strong, 
the  second  feeble  ;  every  three  or  four  contractions  were  followed  by  a 
pause,  lasting  as  long  as  a  complete  heart  -cycle.  One  drachm  of 
digitalis  was  added  to  the  former  treatment.  The  quinine  sulphate 
produced  variations  in  temperature  as  on  the  previous  day. 

On  the  13th  the  patient  was  prostrate  and  refused  all  food.  The 
extremities  were  cold.  Respiration  28;  pulse  76;  temperature  39*8"C. 
The  zone  of  dulness  was  stationary.  On  auscultation  borborygmus 
was  heard  far  in  advance  of  the  diaphragm.  Crepitation  was 
increased  and  a  slight  tubal  murmur  could  be  heard.  The  cardiac 
pauses  were  miore  frequent,  and  occurred  after  every  two  or  three  beats. 
The  pulse  was  feeble  and  intermittent,  in  sympathy  with  the  heart,  The 
urine  contained  18  grains  of  albumen  per  pint. 

The  weather  being  mild  and  bright,  the  animal  was  led  from  its 
stall  and  fastened  in  the  open  air  from  midday  to  3  p.m.  On  return- 
ing to  the  stable  it  began  to  eat.  The  respiration  was  less  rapid  and 
difficult,  the  pulse  good ;  the  temperature  remained  at  39*7°  C. 
Sulphate  of  quinine  in  similar  doses  as  on  the  previous  day  produced 
no  sensible  diminution. 

On  the  14th  the  general  condition  had  improved.  The  animal  took 
several  quantities  of  gruel,  ate  its  hay,  and  drank  8  quarts  of  milk. 
Respiration  22  ;  pulse  72  ;  temperature  39'6°  C.  The  condition  of  the 
chest  remained  as  on  the  previous  day,  though  a  few  crepitant  rales 
were  heard  at  points.     The  irregularity  of  the  heart  continued. 

Treatment. — Sulphate  and  bicarbonate  of  soda  were  administered, 
but  the  alcohol,  sulphate  of  quinine,  and  digitalis  were  discontinued. 

On  the  15th  improvement  was  more  marked.  The  animal  took 
note  of  its  surroundings.  Respiration  20  ;  pulse  68  ;  temperature 
39"4°  C.  Respiration  was  freer,  the  zone  of  dulness  lower,  and  moist 
crepitant  rales  occurred  over  a  large  surface.  The  cough  was  loose  and 
paroxysmal,  and  accompanied  by  discharge.  The  cardiac  pauses  were 
less  frequent  and  longer  than  at  first.  They  lasted  considerably  longer 
than  a  cardiac  cycle ;  the  second  sound  continued  feeble,  and  was 
sometimes  imperceptible.  There  was  no  dulness,  though  still  some 
moist  crepitant  rales. 


PNEUMONIA. 


On  the  i6th  improvement  became  more  pronounced.  Respiration 
i8  ;  pulse  58  ;  temperature  38"9°  C. 

During  the  following  days  the  last  symptoms  disappeared,  the 
cardiac  intermittency  becoming  less  and  less  frequent  until  it  finally 
disappeared. 

On  the  25th  the  animal  left  hospital  entirely  cured. 

184.  A  seven-year-old  mare  left  in  hospital  April  nth,  1899.  Had 
come  from  a  stable  in  which  contagious  pneumonia  was  raging ; 
affected  three  days  before  entry.  The  animal  only  ate  part  of  its  food, 
but  suffered  from  a  cough.     There  was  no  other  history. 

Condition  on  Entry. — The  animal  moved  stiffly.  The  eye  was  re- 
tracted into  the  orbit  and  half  covered  by  the  upper  lid  ;  the  con- 
junctiva was  hyperaemic  and  infiltrated  ;  the  extremities  were  cold. 
Respiration  36;  pulse  84  ;  temperature  41-1°  C.  The  pulse  was  fairly 
strong.  The  cough  was  infrequent,  and  when  produced  by  pressing 
on  the  larynx  was  small,  dry,  paroxysmal,  and  inclined  to  return. 
There  was  a  somewhat  abundant  rusty  discharge.  The  lower  part  of 
the  right  lung  was  dull,  and  at  this  point  borborygmus,  heart-sounds, 
and  some  crepitant  rales  could  be  heard  on  auscultation.  At  the 
junction  of  the  lower  and  middle  thirds  crepitant  and  mucous  rales 
were  audible ;  and  in  the  upper  part,  and  over  the  whole  of  the  left 
lung,  the  vesicular  murmur  was  strong.  Except  that  it  contracted 
with  unusual  suddenness  and  force,  the  heart  revealed  nothing  note- 
worthy. 

Treatment. — Bleeding,  mustard  application  to  the  chest,  quinine 
sulphate  four  drachms,  sodium  bicarbonate  three  and  a  half  ounces. 
Evening  temperature  40*6°  C. 

Next  day  the  patient  appeared  less  depressed.  Respiration  36; 
pulse  80  ;  temperature  40-5°  C.  Percussion  showed  increase  in  the 
zone  of  dulness,  especially  in  front.  On  auscultation  a  slight  tubal 
murmur  was  heard.  Left  lung  normal.  At  9.30  a.m.  the  thermo- 
meter marked  40-5°  C.  Two  and  a  half  drachms  of  quinine  sulphate 
were  given  in  electuary.  At  10.30  a.m.  and  during  the  next  two  hours 
temperature  40-8°  C. ;  at  i  p.m.  407°  C. ;  at  2  p.m.  40-5°  C. ;  at  3  p.m. 
40-2°  C.  ;  at  4  p.m.  40*4°  C.  The  second  dose  was  then  given.  At 
4.30  p.m.  temperature  40'6°  C.  ;  at  5  p.m.  407°  C. ;  at  7  p.m.  40*4°  C. ; 
at  8,30  p.m.  40-2°  C.  The  urine,  which  was  very  deep  in  colour,  con- 
tained eighteen  grains  of  albumen  per  pint. 

On  the  13th  April  the  general  condition  was  bad.  The  animal  lay 
on  the  right  side,  and  was  unable  to  rise  without  assistance.  Respira- 
tion 36  ;  pulse  76 ;  temperature  40°  C.  The  conjunctiva  still  remained 
deeply  injected.  The  respiration  was  short  and  sighing.  On  per- 
cussion and  auscultation  of  the  chest  the  physical  signs  were  as  on  the 
previous  evening,  except  that  the  murmur  was  somewhat  stronger. 
The  heart-sounds  were  weaker.  During  the  day  three  subcutaneous 
injections  of  two  and  a  half  drachms  of  ether  were  given  ;  four  drachms 
of  quinine  were  administered  in  two  doses.  At  g.30  a.m.,  before  the 
first  dose,  the  temperature  was  40°  C.  ;  at  10  a.m.  40°  C. ;  at  11  a.m. 
39-8°  C. ;  at  midday  39*6°  C. ;  at  i  p.m.  39-5°  C.  ;  at  2  p.m.  39-4°  C. 


49°  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 

The  animal  lay  down,  but  rose  at  the  end  of  an  hour.  At  this  time  the 
temperature  was  40*3°  C. ;  at  4  p.m.  40*6°  C,  The  second  dose  of 
quinine  was  given.  Temperature  at  5  p.m.  40*4°  C. ;  at  6  p.m. 
40*5°  C. ;  at  8.30  p.m.  40*2°  C. 

On  the  14th  the  general  condition  remained  stationary.  Tempera- 
ture 39*3°  C.  Respiration  was  still  more  rapid  and  sighing.  The 
pulmonary  dulness  was  unaltered,  the  tubal  murmur  strong.  The  left 
lobe  remained  normal. 

The  heart  showed  signs  of  weakness  and  irregular  intermittency ; 
the  second  sound  was  diminished,  and  almost  lost  at  certain  moments. 
The  patient  took  the  greater  part  of  its  food.  One  and  a  quarter 
drachms  of  digitalis  were  added  to  its  medicine.  At  9  a.m.,  the  tem- 
perature being  39*3°  C,  two  drachms  of  quinine  sulphate  were  given. 
Temperature  at  io  a.m.  38*9°  C. ;  at  11  a.m.  38*8°  C. ;  at  midday 
38*6°  C.  ;  at  I  p.m.  39'i°  C. ;  at  3  p.m.  39*0°  C.  At  4  p.m.  the  second 
dose  of  two  drachms  of  quinine  was  given.  At  5.30  p.m.  the  tempera- 
ture was  39"i°  C. ;  at  6  p.m.  39°  C.  ;  at  8  p.m.  39°  C.  The  animal 
was  very  weak,  and  during  the  day  lay  down  several  times.  It  re- 
ceived three  subcutaneous  injections  of  two  and  a  half  drachms  of  ether. 

On  the  15th  it  was  still  greatly  depressed.  Temperature  39*4° 
to  39"8°  C. ;  respiration  48  ;  pulse  76.  The  lower  half  of  the  right  lung 
remained  dull  on  percussion,  though  to  a  less  degree  at  certain  points. 
Over  the  tenth  and  eleventh  ribs,  near  the  (vertical)  centre  of  the 
chest,  was  an  area  of  tympanic  resonance  as  large  as  the  palm  of  a 
man's  hand.  On  auscultation  crepitant  rales  were  heard  in  the  pos- 
terior portion  of  the  lung,  and  mucous  rales  about  the  centre.  The 
left  lung  appeared  normal  on  auscultation.  The  iirst  heart-sound  had 
a  metallic  ring,  the  second  was  dull.  The  cough  was  strong  and  loud. 
A  little  whitish  discharge  ran  from  the  nostrils.  One  drachm  of  digi- 
talis, three  and  a  half  ounces  of  sodium  bicarbonate,  three  and  a  half 
fluid  ounces  of  alcohol,  and  carbolic  enemata  were  given. 

On  the  1 6th  the  temperature  was  39*4°  C.  Respiration  was  less 
rapid,  but  continued  short  and  sighing.  Crepitant  rales  were  heard 
in  the  upper  thirds  of  the  right  lung,  but  in  the  lower  third  only  heart- 
sounds  could  be  detected.  Cough  was  frequent.  During  the  night 
the  animal  lay  down  on  the  right  side,  and  showed  so  much  excite- 
ment that  a  fatal  isSue  was  feared.     It  was  lifted  and  placed  in  slings. 

,On  the  17th  respiration  30;  temperature  39"8°  C.  Crepitation, 
alternating  with  localised  liquid  sounds,  was  heard  over  the  entire  area 
of  the  right  lung.  The  heart-beats  were  scarcely  perceptible.  The 
pulse  could  not  be  counted. 

Treatment  as  on  the  previous  day.  The  allowance  of  hay  was 
eaten  ;  the  gruel,  etc.,  refused.     The  urine  still  remained  albuminous. 

On  the  i8th  weakness  was  extreme.  Temperature  39'6°  C.  Aus- 
cultation of  the  right  lung  revealed  the  same  liquid  sounds  as  on  the 
previous  day.  The  animal's  hind  legs  seemed  painful.  At  9  a.m.  it 
was  taken  out.  It  moved  with  difficulty.  The  right  hind  limb  was 
paralysed,  the  joints  yielded,  and  the  limb  rested  on  the  fetlock  when- 
ever weight  was  placed  on  it.  The  symptoms  resembled  those  of 
paralysis  of  the  great  sciatic.     The  patient  refused  to  walk,  and  leaned 


PNEUMONIA. 


491 


against  the  wall.  Sensation  was  lost  throughout  the  affected  limb 
except  in  the  region  served  by  the  femoral  nerve ;  it  was  intact  in  the 
left  limb  and  in  all  the  other  hind  parts.  At  3  p.m.  the  animal  la)' 
down  on  the  left  side,  became  greatly  excited ;  respiration  was  moan- 
ing, and  death  occurred  during  the  night. 

Autopsy. — Muscles  pale;  mesentery  and  epiploon  congested;  liver 
large,  friable,  and  of  pale  colour;  spleen  and  kidneys  normal. 

In  the  pleural  sac  was  a  little  yellowish  serosity.  The  right  lung 
had  not  collapsed,  but  adhered  by  its  anterior  lobe  to  the  costal  pleura, 
and  by  its  postero-inferior  part  to  the  mediastinum.  It  showed  lesions 
of  lobular  pneumonia.  According  to  the  point  chosen  it  appeared 
black,  bluish,  deep  red,  bright  red,  or  greyish  in  colour,  the  tints  cor- 
responding to  centres  of  hepatisation,  oedema,  or  emphysema.  Palpa- 
tion revealed  dense  hepatised  areas,  separated  by  yielding  tracts  of 
healthy  pulmonary  tissue.  Sections  of  the  upper  and  posterior  parts 
appeared  emphysematous,  congested,  or  cedepiatous,  according  to  the 
point  chosen  ;  the  middle  region  showed  hepatised  areas,  purulent 
centres,  and  cedema.  One  of  the  abscesses  contained  a  fragment  of 
necrotic  tissue  as  large  as  an  orange.  Some  of  the  bronchioles  were 
obstructed    by  fibrinous   clots.     The  left   lung  was    unaffected.      The 


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Chart  VIII. 


hepatised  centres  in  the  right  lobe  contained  large  numbers  of  different 
bacteria,  streptococci  and  staphylococci  predominating. 

The  heart  was  large,  and  showed  ecchymoses  along  the  vascular 
furrows,  particularly  at  the  base  of  the  ventricles.  It  was  discoloured, 
the  greater  part  of  the  left  ventricle  being  stained  yellow,  but  the  col- 
oration was  less  marked  over  the  right.  Sections  were  deep  red,  pale 
red,  or  yellowish  in  colour.  On  laying  open  the  left  ventricle  the 
decoloration  of  the  myocardium  was  very  striking  ;  the  muscle  appeared 
greyish  yellow,  and  was  dotted  with  ecchymotic  patches  under  the 
endocardium  and  pericardium.  Its  tissue  was  infiltrated ;  the  surface 
of  sections  was  covered  with  a  viscous  exudate.  The  mitral  valves 
were  intact ;  the  aortic  sigmoid  valves  were  thickened  and  infiltrated, 
showed  a  few  light   red  spots  at  their  base,  and  several  little  hard. 


492  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 

fibrous  patches,  which,  however,  were  of  earher  date  than  the  pulmonary 
disease.  The  endocardium  and  valves  of  the  right  side  appeared 
unaffected.  The  great  sciatic  nerve  of  the  right  side  was  exposed 
throughout  ;  its  upper  part  displayed  a  few  disseminated  haemorrhagic 
points.  The  spinal  cord  appeared  normal.  Microscopic  examination 
of  the  cardiac  and  nervous  tissues  failed  to  reveal  the  presence  of 
microbes,  and  inoculation  of  gelatin  and  agar  with  scrapings  from 
these  tissues  produced  no  growths. 

Remarks. — In  equine  pneumonia,  quinine  sulphate  in  doses  of  i-j  to 
2^  drachms,  according  to  the  size  of  the  patient,  repeated  twice  a  day, 
usually  causes  temporary  lowering  of  temperature.  Excessive  doses 
produce  excitement  and  hyperthermia,  as  in  Case  182,  where  the 
animal  was  of  medium  size,  and  2^  drachms  was  an  overdose. 

185.  A  six-year-old  entire  horse,  bought  six  weeks  before,  and  left 
in  hospital  April  2gth,  1899.  Had  been  kept  in  a  stable  where  out- 
breaks of  pneumonia  were  frequent.  In  consequence  of  an  attack  of 
acute  enteritis  at  the  commencement  of  April  it  had  been  rested  for 
nearly  three  weeks.  On  the  27th  April  it  showed  symptoms  suggestive 
•of  pneumonia,  and  was  sent  here  two  days  later. 

State  on  Examination. — Seen  in  its  stall,  the  animal  seemed  greatly 
depressed,  and  hung  back  from  the  manger,  with  its  head  low  and  eyes 
half  closed.  The  conjunctiva  was  yellowish ;  the  mouth  moist  and 
hot ;  the  artery  tense  ;  the  pulse  feeble  ;  the  cough  small  and  paroxysmal. 
Nothing  was  noted  on  auscultation  or  percussion.  Respirations  26, 
pulse  68,  temperature  40'5°  C. 

Treatment. — Mustard  was  applied  to  the  chest,  causing  the  tempera- 
ture to  fall  eight  tenths  of  a  degree ;  internally,  alcohol,  bicarbonate  of 
soda,  and  warm  creolin  enemata  were  prescribed,  while  8  ounces  of 
normal  salt  solution  were  injected  subcutaneously. 

On  the  30th  the  condition  was  graver  ;  torpor,  loss  of  appetite,  and 
injection  of  the  visible  mucous  membranes  were  noted,  and  a  dark  line 
had  developed  along  the  gums.  Respirations  35,  pulse  75,  temperature 
40'4°  C.  On  auscultation  the  vesicular  murmur  extended  over  the 
entire  area  of  both  pulmonary  lobes.  No  abnormal  sound  could  be 
heard.  Apart  from  its  rapid  action  the  heart  showed  nothing  particu- 
lar.    The  evening  temperature  was  40"6°  C. 

On  the  ist  May  the  general  condition  remained  as  on  the  previous 
evening.  Respirations  32,  pulse  75,  temperature  30*9°  C.  The  con- 
junctivae were  saffron-yellow;  the  pulse  feeble;  there  was  abundant 
rust-coloured  discharge  from  the  nose ;  inspiration  was  oppressed,  and 
expiration  sighing.  Cough  was  frequent.  On  the  left  side  the  zone  of 
dulness  extended  as  high  as  the  point  of  the  elbow.  On  auscultation, 
crepitation  and  a  slight  tubal  murmur  could  be  heard.  On  the  right 
side  the  lower  part  of  the  chest  revealed  partial  dulness,  but  no  abnor- 
mal sounds.  The  heart-beats  were  strong  and  slightly  irregular.  The 
same  treatment  was  continued,  but  a  dose  of  digitalis  was  also  given. 
Sixteen  ounces  of  "8  per  cent,  salt  solution  were  injected.  During  the 
following  hours  the  temperature  fell  a  few  tenths.  In  the  evening 
•respirations  35,  pulse  84,  temperature  40*4°  C. 


PNEUMONIA.  493 

On  the  2nd  the  general  condition  remained  bad,  and  appetite  was 
entirely  lost.  There  was  frequent  cough  and  rust-coloured  discharge. 
The  pulse  was  feeble.  Dulness  had  markedly  extended  on  the  left 
side,  and  rose  to  the  middle  third  of  the  thorax  ;  on  the  right  a  loud 
tubal  murmur  was  heard  during  inspiration  and  expiration.  Respira- 
tion 40  ;  pulse  80  ;  temperature  397°  C.  During  the  afternoon  the 
horse  was  led  out  and  left  in  the  open  air  for  several  hours.  Micro- 
scopical examination  of  the  discharge  resulted  in  several  varieties  of 
microbes  being  found,  though  two  streptococci,  one  of  which  stained 
by  Gram's  method,  predominated.  During  the  evening  the  heart's 
action  became  very  rapid,  the  pulse  feeble,  the  respiration  extremely 
difficult,  and  the  face  anxious.  Twelve  and  a  half  fluid  ounces  of  salt 
solution  and  five  and  a  half  fluid  drachms  of  ether  were  injected.  The 
thorax  and  limbs  were  rubbed  with  mustard.  At  7  o'clock  the  tem- 
perature was  39'4°  C.  Another  subcutaneous  injection  of  ether  was 
given. 

At  3  o'clock  the  general  condition  was  similar  to  that  on  the 
previous  day.  Respiration  44  ;  pulse  82  ;  temperature  39'4°  C.  The 
nasal  discharge  had  ceased;  the  conjunctiva  was  deep  red;  the 
pulse  perceptible  with  difficulty  ;  dulness  had  increased  on  both  sides  ; 
there  was  tympanic  resonance  on  the  left.  During  both  stages  of 
respiration  and  on  both  sides  of  the  chest  a  loud  tubal  murmur  could 
be  heard.  The  cardiac  sounds  were  feeble.  The  former  treatment 
was  continued.  Two  and  a  quarter  fluid  drachms  of  ether  were 
injected.  Night  and  morning  the  horse  was  led  out  of  the  stable  and 
left  in  the  open  air  for  several  hours,  provided  the  weather  was  good. 
The  urine  did  not  contain  albumen  or  bile  pigments. 

On  the  4th  respiration  44;  pulse  84;  temperature  39°  C.  General 
condition  improved.  The  animal  was  less  depressed,  and  for  the  first 
time  after  entering  hospital  fed  voluntarily.  The  tubal  murmur  and 
tympanic  resonance  on  the  right  side  persisted.  The  hind  limbs  were 
a  little  swollen.  The  same  treatment  was  continued.  In  the  evening 
respiration  40  ;  pulse  80  ;  temperature  39'2°  C. 

On  the  5th  the  rapidity  of  breathing  contrasted  with  the  improve- 
ment in  the  general  symptoms.  Respiration  50  ;  pulse  88  ;  temperature 
39*2°  C.  The  dulness  and  tj'mpanic  resonance  continued  ;  the  tubal 
murmur  was  less  marked.  Crepitation  and  loud  mucous  rales  were 
heard.  Small  subcutaneous  abscesses  developed  in  different  regions. 
The  same  treatment  was  continued.  In  the  evening  respiration  60; 
pulse  78  ;  temperature  39*3°  C. 

On  the  bth  the  pulmonary  symptoms  were  still  marked,  but  the 
patient  readily  took  food.  The  conjunctiva  was  rose-coloured,  the 
pulse  feeble ;  the  respiration  was  more  regular.  Respiration  42  ;  pulse 
70  ;  temperature  38*6°  C.  On  both  sides  of  the  chest  a  tubal  murmur 
and  crepitation  could  be  heard.  Percussion  revealed  dulness  with 
areas  of  tympanic  resonance.  In  the  evening  respiration  42  ;  pulse  70  ; 
temperature  38'7°  C. 

On  the  7th  dulness  had  almost  disappeared  from  the  left  side.  On 
auscultation  crepitant  and  sibilant  rales  were  still  audible.  On  the 
right  a  tubal  murmur  and  crepitation  were  noted.     The  heart-beats 


494 


CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 


were  regular  and  fairly  strong,  and  the  pulse  was  good.  Respiration  38  ; 
pulse  72  ;  temperature  38*5°  C. 

On  the  8th  the  general  condition  was  excellent.  On  auscultation 
the  tubal  murmur  had  disappeared,  and  diffuse  crepitation,  together 
with  bronchial  rales,  was  heard  on  both  sides.  Respiration  34  ;  pulse 
74;  temperature  39*3°  C.  Treatment  was  reduced  to  administration 
of  sodium  sulphate  and  bicarbonate. 

On  the  13th  the  respiration  was  still  26,  pulse  74,  and  temperature 
a  little  over  38°  C.  On  the  14th  and  15th  the  breathing  diminished 
in  frequency.  During  the  following  days  the  last  troubles  disappeared. 
On  the  i8th  the  temperature  was  38°  C. 

A  week  after  leaving  hospital  the  horse  was  brought  back  again 
suffering  from  a  deep-seated  metapneumonic  abscess  in  the  withers. 
The  pus  contained  streptococci. 

186.  A  five-year-old  gelding,  entered  hospital   March   15th,  1899. 


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Chart  IX. 


For  some  days  it  had  been  dull,  had  eaten  little,  and  coughed 
frequently.  It  had  been  treated  for  pulmonary  attack  during  the 
spring  of  1898. 

State  on  Examination. — The  animal  was  stiff,  and  moved  with 
difficulty;  the  conjunctiva  was  deep  yellow;  the  breathing  and  pulse 
were  very  rapid ;  the  cough  was  strong  and  loose.  Percussion  of  the 
thorax  failed  to  reveal  dulness.  On  auscultation  some  moist  crepitant 
rales  were  heard  in  the  lower  part  of  the  left  lung ;  the  heart-sounds 
were  normal  and  the  pulse  was  good.  The  animal  ate  slowly  but 
consumed  all  its  food.     Respiration  25;  pulse  70;  temperature  41°  C. 

Treatment. — Injection  into  the  jugular  vein  of  five  and  a  half  fluid 
drachms  of  i  per  cent,  iodine  solution.  At  7  p.m.  respiration  27 ; 
pulse  60;  temperature  41*4°  C. 

Next  day  respiration  27 ;  pulse  60  ;  temperature  408°  C.  Partial 
dulness  and  crepitant  rale  in  the  lower  part  of  the  left  lung.  Nothing 
on  the  right  side.     During  the  day  three  intra-venous  injections  of  two 


PNEUMONIA.  495 

and  a  half  fluid  drachms  of  the  iodine  sohition  were  made.  The 
animal  ate  slowly,  but  consumed  its  oats  and  hay.  In  the  evening 
respiration  32  ;  pulse  65  ;  temperature  4i'3°  C. 

On  the  17th  respiration  30  ;  pulse  67  ;  temperature  40"5°  C.  In 
the  lower  third  of  the  left  lung  was  a  zone  of  dulness  limited  by  a  line 
drawn  obliquely  downwards  and  backwards.  Over  this  area  a  trifling 
tubal  murmur,  and  towards  the  upper  part  some  crepitation,  were 
heard.  The  appetite  still  remained  good.  The  same  treatment  was 
continued.  In  the  evening  respiration  34  ;  pulse  70  ;  temperature 
41°  C. 

On  the  i8th  respiration  82;  pulse  65  ;  temperature  40*3°  C.  The 
patient  was  less  depressed  than  on  the  preceding  days.  The  dull  zone 
was  larger,  the  tubal  murmur  strong,  and  there  was  more  crepitation. 
The  heart-beats  were  feeble  but  regular.  The  cough  was  frequent  and 
strong  ;  the  mucous  membranes  were  slightly  injected.  Two  intra- 
venous injections  of  4  fluid  drachms  of  iodine  solution  were  made. 
In  the  evening  respiration  37  ;  pulse  70 ;  temperature  40*4'^  C. 

On  the  19th  respiration  35  ;  pulse  68  ;  temperature  40°  C. 
Dulness  over  the  lower  half  of  the  left  lung ;  the  tubal  murmur 
remained  marked.  The  heart  beat  regularly  ;  the  pulse  was  rather 
feeble.  During  the  day  the  breathing  became  rapid.  The  animal  took 
note  of  what  occurred  around  it ;  it  did  not  leave  any  of  its  food. 
Same  treatment  continued.  In  the  evening  respiration  50  ;  pulse  66  ; 
temperature  40°  C. 

On  the  20th  respiration  45  ;  pulse  62  ;  temperature  39*1°  C  The 
zone  of  dulness  was  stationary;  the  murmur  persisted  ;  the  pulse  was 
small,  the  conjunctiva  slightly  yellow  ;  the  appetite  was  preserved. 
Same  treatment  continued.  In  the  evening  respiration  35  ;  pulse  60  ; 
temperature  38*9°  C. 

On  the  2ist  respiration  35  ;  pulse  52  ;  temperature  38-2°  C.  The 
dull  zone  had  diminished  in  size ;  the  tubal  murmur  was  weaker ;  the 
crepitant  rale  indicating  resolution  had  returned  ;  the  pulse  had  again 
become  large  and  strong.  The  animal  was  exercised  for  a  quarter  of 
an  hour.  Same  treatment  continued.  In  the  evening  respiration  ^y  ; 
pulse  50  ;  temperature  38*4°  C. 

On  the  22nd  respiration  2>i'^  pulse  43;  temperature  38-4°  C. 
Dulness  had  almost  disappeared.  On  auscultation  only  a  slight  tubal 
murmur  and  a  few  crepitant  rales  were  noted.  Exercised  in  the  sun 
during  the  afternoon,  the  patient  was  bright  and  walked  with  freedom. 
On  returning  to  its  box  it  ate  with  good  appetite.  Same  treatment  con- 
tinued. In  the  evening  respiration '34  ;  pulse  43  ;  temperature  38-3°  C. 
On  the  23rd  respiration  30;  pulse  40;  temperature  38-2°  C.  There 
were  still  a  few  crepitant  rales.  No  cardiac  disturbance.  The  animal 
lay  down  during  the  day,  but  rose  on  the  slightest  disturbance.  The 
iodine  treatment  was  stopped,  and  one  and  a  half  ounces  of  sodium 
bicarbonate  were  given  in  the  drinking-water.  In  the  evening 
respiration  30  ;  pulse  45  ;  temperature  38°  C. 

On  the  24th  respiration  22  ;  pulse  40 ;  temperature  38°  C.  No 
abnormal  sound  was  heard  on  auscultation.  There  were  no  after 
complications. 


496  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


PURPURA    HEMORRHAGICA. 

187.  A  six-year-old  entire  horse,  brought  for  examination  on  the 
5th  March,  1897,  suffering  from  a  corn  in  the  off  fore-foot.  The  bar 
and  branch  of  the  sole  were  thinned,  the  foot  reshod,  and  a  tar 
dressing  applied. 

On  the  loth  March  the  horse  was  returned  here.  For  two  days 
before  all  four  limbs  had  been  swollen  and  oedematous. 

State  on  Examination. — The  swellings  were  of  considerable  size,  and 
extended  as  high  as  the  elbows  and  stifles,  where  they  were  sharply 
delimited.  The  mucous  membrane  of  the  nose  was  covered  with 
petechias.  There  was  no  swelling  about  the  face.  Walking  was 
difficult,  the  limbs  being  carried  stiffly  and  not  being  flexed.  The 
appetite  was  good.  Temperature  38*4°  C.  During  the  previous  three 
years  four  cases  of  purpura  hsemorrhagica,  three  of  which  had  ended 
fatally,  had  occurred  in  the  stable  from  which  this  patient  came. 

Treatment. — Injection  into  the  connective  tissue  of  the  neck  of 
three  and  a  half  fluid  ounces  of  normal  horse  serum.  During  the  five 
following  days  four  to  four  and  a  half  fluid  drachms  of  this  serum  were 
injected  in  the  region  of  the  neck,  over  the  triceps  muscles,  and  into 
the  front  of  the  chest. 

On  the  i6th  swelling  of  the  fore-limbs  had  diminished  ;  that  of  the 
hind  remained  as  before.  There  was  little  fever,  the  temperature  only 
rising  a  few  tenths  of  a  degree  above  normal  ;  appetite  was  preserved. 
The  treatment  was  continued. 

On  the  19th  the  swelling  in  all  four  limbs  was  diminishing. 
A  trifling  whitish  discharge  ran  from  both  nostrils ;  it  continued  for  a 
week.  Serum  was  injected,  and  one  and  a  half  ounces  of  sodium 
bicarbonate  were  administered  on  alternate  days. 

The  animal  left  hospital  on  the  31st  March,  the  swelling  of  the 
limbs  having  completely  disappeared. 

188.  A  ten-year-old  gelding  entered  hospital  December  loth,  1897, 
Had  been  attacked  with  paraplegia  a  month  before,  and  had  afterwards 
suffered  from  the  abdominal  form  of  influenza.  Still  showed  traces  of 
bleeding  from  the  jugular  and  blistering  of  the  dorso-lumbar  region. 
Had  been  rested  since  the  25th  November.  On  the  9th  December 
signs  of  purpura  appeared.  Was  brought  to  the  school  on  the  evening 
of  the  next  day. 

State  on  Examination. — The  limbs  were  swollen  as  high  as  the  upper 
third  of  the  forearm  and  thigh.  The  left  side  of  the  breast  and  the 
right  of  the  abdomen  showed  oedematous  patches ;  the  lower  half  of 
the  head  was  swollen  ;  the  nose,  face,  lips,  and  cheeks  were  greatly 
infiltrated.  Blood-stained  discharge  ran  from  both  nostrils ;  the 
mucous  membrane  of  the  nose  exhibited  blackish  ecchymoses,  almost 
everywhere  confluent.  The  respiration  was  60  per  minute  and  noisy  ; 
temperature  397°  C. 

Treatment. — The  swelling  about  the  head  was  perforated  in  about 
thirty  spots  with  the  fine  needle  of  the  thermo-cautery,  allowing  a 
large  quantity  of  reddish  serosity  to  escape.     Four  and  a  half  fluid 


PURPURA    HEMORRHAGICA.  497 

ounces  of  normal  horse  serum  were  injected  ;  six  and  a  half  ounces  of 
sodium  sulphate  and  three  and  a  quarter  ounces  of  alcohol  were  given 
in  the  drinking-water.  During  the  night  the  difficulty  in  breathing 
increased,  and  tracheotomy  had  to  be  performed. 

On  the  nth  the  general  condition  remained  stationary.  The 
breathing,  however,  was  easier,  and  much  less  rapid  than  on  the  pre- 
vious evening.  Temperature  39"o°  C.  During  that  and  the  next  day 
four  and  a  half  fluid  ounces  of  normal  horse  serum  were  injected  in 
three  separate  quantities. 

On  the  13th  the  head  and  fore-limbs  were  less  swollen  ;  the  oedema- 
tous  patch  on  the  thorax  was  undergoing  absorption  ;  that  on  the 
abdomen  remained  as  large  as  before,  and  had  extended  to  the  sheath. 
An  oedematous  zone  of  considerable  size  had  developed  around  the 
tracheotomy  wound.  Temperature  3g'0°  to  39'5°  C.  The  injections 
of  serum  were  continued. 

During  the  three  following  days  the  head  continued  to  diminish  in 
size  ;  the  swelling  in  the  limbs  remained  stationary ;  the  patch  on  the 
neck  gravitated  towards  the  breast,  and  increased ;  whilst  that  on  the 
abdomen  advanced  beneath  the  thorax.     Temperature  38'5°  to  38*8  C. 

On  the  17th  the  swellings  about  the  front  of  the  body  had  greatly 
diminished,  as  had  those  on  the  hind  limbs  and  abdomen.  The 
tracheal  tube  was  removed,  and  the  wound  swabbed  with  20  per  cent, 
iodine  solution.  Temperature  39*0°  to  39*3°  C.  Treatment  was  sup- 
plemented by  the  daily  administration  of  two  ounces  of  sodium  bicar- 
bonate. 

On  the  22nd  the  oedema  had  almost  disappeared  at  all  points ;  tem- 
perature 38*0°  C.  The  serum  injections  were  discontinued  ;  the 
patient  was  exercised  night  and  morning. 

A  week  later  it  had  entirely  recovered. 

189.  An  eight-year-old  entire  horse,  left  in  hospital  December  i8th, 
1897,  to  be  treated  for  bronchitis.  Double  pneumonia  afterwards 
developed  ;  its  onset  was  insidious,  but  the  real  nature  of  the  disease 
was  clearly  shown  by  the  moist  crepitation  and  tubal  murmur  on  both 
sides,  and  by  the  dulness  of  a  considerable  area  of  both  lungs. 

The  pneumonia  commenced  on  the  8th  January.  On  the  22nd  the 
temperature  still  varied  between  39-0°  and  39*6°  C.  Cough  persisted, 
and  was  accompanied  by  a  double-sided  muco-purulent  discharge,  in 
which  streptococci  and  some  staphylococci  were  found  on  bacterio- 
logical examination.  The  appetite  was  capricious.  Percussion 
revealed  dulness  over  the  anterior  part  of  the  right  lung.  On  auscul- 
tation moist  rales  were  heard.  A  patch  of  chronic  pneumonia  was 
suspected.  The  principal  drugs  used  were  iodide  of  potassium  and  oil 
of  turpentine. 

On  the  27th  the  hind  limbs  were  swollen,  and  an  oedematous  patch, 
as  large  as  a  man's  hand,  appeared  on  the  right  side  of  the  abdomen. 
The  Schneiderian  membrane  showed  a  few  petechias.  Temperature 
38*9°  C. ;  respiration  17  ;  pulse  40. 

Trmf7;?^n^.— Subcutaneous  injection  of  three. and  a  quarter  fluid 
ounces  of  normal  horse  serum.  • 

T  I 


498  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 

On  the  28th  the  general  condition  was  bad  and  the  appetite  poor. 
The  hind  limbs  showed  greater  swelling,  sharply  defined  at  the  upper 
part.  Temperature  40*0°  to  39*8°  C. ;  respiration  23  ;  pulse  43.  Treat- 
ment continued. 

On  the  2gth  the  fore-limbs  and  the  lower  part  of  the  head  became 
swollen  ;  breathing  was  accompanied  by  a  wheezing  sound.  Tempera- 
ture 397°  to  40*0°  C.  ;  respiration  18 ;  pulse  40. 

For  three  days  six  and  a  half  fluid  ounces  of  serum  were  injected 
daily.     The  condition  remained  stationary  until  the  ist  February. 

On  the  2nd  the  swelling  about  the  face  had  diminished ;  the  respi- 
ration was  free,  and  the  appetite  good.  Temperature  39*5°  to  40*0° 
C. ;  respiration  20  to  24 ;  pulse  45. 

On  the  following  days  the  swellings  were  smaller.  The  injections 
were  continued. 

On  the  5th  the  swelling  about  the  face  had  disappeared  ;  that  on 
the  limbs  and  abdomen  had  diminished.  One  and  a  half  ounces  of 
sodium  bicarbonate  were  given  in  the  drinking-water. 

On  the  9th  the  swellings  were  almost  entirely  re-absorbed.  Tem- 
perature 38*4°  to  39*3°  C.  ;  respiration  15  ;  pulse  42.  Only  three  and  a 
quarter  fluid  ounces  of  serum  were  injected,  one  and  a  half  ounces  of 
sodium  bicarbonate  being  given  daily  in  the  drinking-water. 

Some  necrotic  patches  of  skin  sloughed  away  from  the  scrotum. 

On  the  17th  the  horse  had  fully  recovered. 

TETANUS. 

190.  A  three-year-old  entire  horse,  entered  hospital  November  4th, 
1896. 

State  on  Examination. — Various  groups  of  muscles,  especially  those 
about  the  neck,  showed  tonic  contraction  ;  the  head  was  extended  on 
the  neck  ;  there  was  slight  trismus  ;  the  eyes  were  partly  withdrawn 
into  the  orbit,  were  immobile,  and  covered  by  the  membrana  nictitans  ; 
the  tail  was  held  horizontally,  and  the  limbs  were  stiff.  Respiration 
30  ;  pulse  50  ;  temperature  38"5°  C. 

No  wound  could  be  discovered  on  the  skin  or  mucous  membranes. 
The  front  of  the  off  hind  fetlock  exhibited  a  cicatrix  resulting  from 
an  injury  inflicted  six  months  before.  All  four  feet  showed  a  little 
thrush. 

Treatment. — The  frogs  were  cleansed ;  the  median  lacunae  carefully 
wiped  out,  swabbed  to  the  bottom  with  tincture  of  iodine,  and 
covered  with  tar. 

The  patient  was  placed  in  a  dark  box  and  given  three  and  a  half 
ounces  of  sodium  sulphate,  one  and  a  quarter  ounces  of  sodium  bi- 
carbonate, and  two  and  a  half  drachms  of  potassium  iodide  daily  in 
the  drinking-water.  Enemata  containing  iodine  and  chloral  were 
also  given. 

During  the  next  four  days  the  condition  remained  stationary,  the 
temperature  varying  between  38°  and  38*5°  C. 

On  the  9th  the  hind  limbs  were  slightly  less  stiff.  The  enemata 
produced  rather  violent  expulsive  efforts,  and  were  stopped. 


TETANUS.  499 

Up  to  the  15th  there  was  no  visible  change.  Each  day  the  animal 
ate  part  of  its  food. 

On  the  i6th  the  condition  was  graver.  Temperature  39"8°  C. ; 
pulse  52  ;  respiration  28.  Mechanical  pneumonia  from  passage  of 
food  into  the  trachea  was  feared.  Auscultation  and  percussion  of  the 
chest  revealed  nothing  abnormal.  The  laryngeal  region  was  slightly 
painful  on  pressure.     The  animal  refused  most  of  its  food. 

From  the  17th  to  the  20th,  three  and  a  half  fluid  ounces  of  alcohol 
were  given  daily  in  the  drinking-water,  and  three  antiseptic  fumigations 
made.  The  symptoms  persisted,  and  were  accompanied  by  attacks  of 
coughing. 

On  the  2ist  there  was  trifling  double-sided  muco-purulent  dis- 
charge ;  the  submaxillary  glands  were  swollen  and  sensitive  ;  the 
temperature  39*6°  C. 

On  the  22nd  discharge  was  more  abundant ;  the  pituitary  mem- 
brane was  deep  red.  The  submaxillary  swelling  had  become  fluctuat- 
ing. Temperature  sg'S*^  C  ;  respiration  22  ;  pulse  56.  The  abscess 
was  opened,  and  the  cavity  irrigated  with  carbolic  solution. 

Next  day  the  general  condition  had  improved.  The  neck  and 
head  were  more  freely  moved.  The  animal  ate  all  its  food  with  the 
exception  of  a  little  hay.  Temperature  39*2°  C  ;  respiration  28  ; 
pulse  78.  During  the  next  few  days  the  last  symptoms  of  sore  throat 
disappeared,  and  the  tonic  contractions  became  less  and  less  marked. 

On  the  28th  there  was  still  slight  stiffness  of  the  ears  and  tail.   ' 

On  the  30th  cure  was  complete. 

191,  A  ten-year-old  entire  horse,  entered  hospital  February  3rd, 
1897.  For  the  previous  three  weeks  a  wound  caused  by  the  collar 
had  existed  on  the  upper  part  of  the  neck.  On  the  3rd  February  the 
animal  worked  during  the  whole  morning,  but  towards  two  o'clock  the 
driver  noticed  signs  of  stiffness  about  the  limbs  and  difficulty  in 
breathing.  He  took  it  to  a  veterinary  surgeon,  who  diagnosed  tetanus. 
The  animal  was  brought  to  Alfort  during  the  evening. 

State  on  Examination. — On  its  arrival  symptoms  of  tetanus  were 
clearly  marked.  Walking  was  difficult,  the  hind  limbs  especially  being 
affected.  The  neck  was  stiff,  the  head  extended,  and  the  tail  elevated. 
There  was  slight  trismus.  Temperature  38*3°  C.  No  other  wound 
except  that  on  the  neck  could  be  discovered. 

Treatment. — The  patient  was  immediately  placed  in  a  dark  box,  and 
the  wound  disinfected  with  5  per  cent,  carbolic  solution  and  tincture  of 
iodine.  Three  and  a  half  ounces  of  sodium  sulphate  and  one  and  a 
half  ounces  of  sodium  bicarbonate  were  given  in  the  drinking-water. 
Milk  ad  libitum  was  allowed.  The  horse  ate  all  its  food,  though  masti- 
cation was  difficult. 

Next  day  the  condition  had  become  slightly  worse.  The  breathing, 
which  had  previously  been  normal,  was  rapid  and  short.  Temperature 
38*4°  C.  The  same  treatment  was  continued,  but  in  addition  eight 
ounces  of  '8  per  cent,  salt  solution  were  subcutaneously  injected.  This 
was  repeated  during  the  following  days.     From  the  5th  fever  ceased. 

On  the   9th   slight  improvement  was  noted.     Movement  was  less 


500  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 

difficult  ;  the  neck  less  stiff;  the  nostrils  less  dilated;  while  respiration 
was  slower  and  easier.  The  injections  of  artificial  serum  produced 
considerable  struggling,  but  nevertheless  were  continued  until  the 
14th. 

From  the  15th  to  the  25th  treatment  was  reduced  to  daily  adminis- 
tration of  four  and  a  half  ounces  of  sulphate  and  one  and  a  half  ounces 
of  bicarbonate  ot  soda.     Improvement  was  slow. 

From  the  25th  to  the  30th  injections  of  artificial  serum  were  re- 
peated, but  they  caused  such  violent  struggling  that  finally  they  had  to 
be  suspended.  Treatment  was,  therefore,  again  restricted  to  adding 
sulphate  and  bicarbonate  of  soda  to  the  drinking-water. 

During  the  early  part  of  March  improvement  occurred  more 
rapidly,  and  by  the  loth  recovery  was  complete. 

192.  An  eleven-year-old  mare,  entered  hospital  October  15th,  1897. 
On  the  25th  September  had  fallen  and  injured  the  right  forearm  and 
knee.  On  the  14th  October  symptoms  of  tetanus  appeared.  The 
animal  was  brought  to  the  school  next  morning.  There  was  trifling 
generalised  muscular  contraction  and  slight  trismus.  Temperature 
was  normal.     The  animal  could  still  eat. 

Treatment. — Disinfection  of  the  wound  and  of  the  knee  and  forearm 
with  3  per  cent,  creolin  solution,  followed  by  tincture  of  iodine.  Eight 
fluid  ounces  of  warm  i  per  cent,  salt  solution  were  injected  into  the 
jugular,  five  ounces  of  sulphate,  and  two  ounces  of  bicarbonate  of  soda 
were  given  in  the  drinking-water.  In  addition  enemata  containing 
chloral  were  administered. 

During  the  next  two  days  the  condition  remained  stationary. 
Respirations  20  ;  temperature  38°  to  38*4°  C.  The  animal  took  gruel, 
hay,  and  oats.     Treatment  as  before. 

On  the  i8th  the  trismus  was  a  little  more  pronounced.  Tempera- 
ture 38*2°  to  38*5°  C.  Nine  and  a  half  fluid  ounces  of  artificial  serum 
were  subcutaneously  injected.  These  injections,  together  with  the 
internal  and  local  treatment,  were  continued  until  the  26th,  on  which  day 
improvement  appeared.  As  the  animal  became  difficult  to  approach 
the  enemata  were  discontinued. 

Until  the  12th  November  a  daily  dose  of  i  to  if  ounces  of  sodium 
bicarbonate  was  given  in  the  drinking-water,  and  from  time  to  time  3  to 
5  ounces  of  sodium  sulphate.  At  the  date  mentioned  recovery  was 
complete.     The  animal  left  hospital  on  the  15th  November. 

193.  A  twelve-year-old  gelding,  entered  hospital  November  29th, 
1896.  Had  been  castrated  four  months  previous!}-  ;  one  of  the  wounds 
had  become  sinuous.  A  week  before,  the  animal's  left  hind  pastern 
had  also  been  injured  by  a  fragment  of  glass.  On  the  29th  November 
the  owner  noticed  that  the  horse  moved  with  difficulty.  The  head  was 
extended  on  the  neck,  the  tail  was  elevated,  and  the  limbs  were  stiff. 

State  on  Entry. — The  patient  showed  symptoms  of  acute  tetanus. 
Tonic  muscular  contraction  was  intense  and  generalised  ;  at  rest  the 
limbs  were  stretched  out  on  either  side,  and  during  movement  were 
advanced    without    being    flexed.       The    tail    was    lifted;    the   head 


TETANUS.  501 

markedly  extended  on  the  neck ;  the  ears  were  directed  forwards,  and 
could  not  be  moved ;  the  membrana  nictitans  covered  part  of  the  globe 
of  the  eye.  Trismus  was  very  marked.  The  animal  made  unsuccessful 
attempts  to  swallow  its  saliva,  which  dribbled  from  the  mouth  in  long 
filaments.  Any  excitement  caused  paroxysms.  Temperature  39'3°  C.  ; 
respirations  78  ;  pulse  85.  A  wound  about  two  inches  in  length,  with 
contused  margins,  was  found  in  the  left  hind  pastern. 

Treatment. — Disinfection  of  the  wcmnds  with  dilute  tincture  of 
iodine,  immersion  of  the  foot  in  a  'i  per  cent,  sublimate  solution,  fol- 
lowed by  iodoform  dressing  of  the  pastern.  The  patient  was  afterwards 
placed  in  a  dark  box  and  fed  with  nourishing  enemata.  At  g  p.m.  75 
grains  of  Behring's  dry  antitoxin,  dissolved  in  iij  fluid  drachms  of  luke- 
warm sterilised  water,  were  injected  into  the  jugular.  The  animal  was 
found  dead  next  morning. 

Autopsy. — Lesions  of  asphyxia;  suppurating  scirrhous  cord;  the 
base  of  the  left  spermatic  cord  was  swollen,  as  large  as  a  hen's  egg,  and 
contained  numerous  suppurating  centres. 

194.  A  four-year-old  gelding,  castrated  on  the  27th  November, 
1896,  in  the  northern  suburbs  of  Paris.  The  operation  was  performed 
by  the  covered  method  with  clams,  and  partial  antiseptic  precautions 
were  taken,  During  the  days  following  operation  the  wounds  were 
washed  with  *i  per  cent,  sublimate  solution  three  times  daily. 

On  the  4th  December  the  clams  were  removed.  Next  morning 
considerable  swelling  of  the  genital  region  appeared,  but  in  a  few  days 
again  diminished.     The  wounds  suppurated  slightly. 

Until  the  20th  December  nothing  unusual  was  seen.  Next  morning, 
however,  symptoms  of  tetanus  appeared,  and  the  horse  was  sent  to 
Alfort. 

State  on  Examination. — Generalised  tonic  contractions  ;  tail  elevated  ; 
head  extended  and  held  stiffly  ;  ears  directed  forwards  ;  membrana 
nictitans  covering  part  of  the  globe  of  the  eye ;  trismus  ;  respiration 
rapid,  varying  between  32  and  36  per  minute  ;  temperature  38°  C. 

Treatment. — The  horse  was  placed  in  a  box.  Every  care  was  taken 
to  guard  it  against  the  action  of  light,  cold,  and  noise.  The  wounds 
were  disinfected.  Morphine  and  chloral  were  given.  During  the  day 
and  ensuing  night  the  symptoms  became  aggravated. 

On  the  morning  of  the  21st  the  skin  was  covered  with  sweat. 
Hypersesthesia  was  very  marked  ;  opening  the  door,  touching  the 
animal,  or  making  the  smallest  noise  produced  paroxysms.  Respira- 
tions 36  ;  pulse  46  ;  temperature  38*2°  C. 

Seventy-five  grains  of  Behring's  dry  antitoxin,  dissolved  in  iij 
drachms  of  lukewarm  sterilised  water,  were  injected  into  the  jugular. 
During  the  day  the  patient  took  milk,  and  in  the  evening  gruel.  Res- 
pirations 36 ;  pulse  48  ;  temperature  38*5°  C. 

On  the  22nd  the  condition  was  more  severe.  The  respirations  were 
70  to  80  per  minute  during  the  attacks.  Seventy-five  grains  of  aqueous 
extract  of  belladonna  and  5  ounces  of  sodium  sulphate  of  soda  were  given 
in  the  drinking-water.  Morphine  was  subcutaneously  injected,  and 
chloral  given  in  enemata. 


502  CLINICAL   VETERINARY    MEDICINE    AND    SURGERY. 

On  the  23rd  the  contractions  and  trismus  had  become  still  more 
exaggerated.  Swallowing  was  impossible.  The  same  treatment  was 
continued,  but  the  animal  died  during  the  night. 

Autopsy.  —Lesions  of  asphyxia. 

195.  A  nine-year-old  gelding,  entered  hospital  May  6th,  1899, 
having  shown  symptoms  of  tetanus  for  two  days  previously.  Came 
from  the  eastern  suburbs  of  Paris.  A  month  before  had  fallen  and 
injured  its  knees. 

State  on  Examination. — The  legs  were  stiff  and  placed  farther  apart 
than  usual ;  the  head  was  extended  on  the  neck.  The  animal  had 
relatively  little  difficulty  in  moving.  The  face  appeared  anxious ;  the 
eyes  were  fixed,  the  nostrils  dilated,  the  ears  drawn  together  and  rigid  ; 
the  tail  was  lifted.  The  least  excitement  caused  the  membrana 
nictitans  to  be  projected  over  the  eye.  Mastication  was  slow,  and 
appetite  diminished;  trismus  was  little  marked.  The  front  of  the  left 
knee  showed  a  circular  wound  the  size  of  a  sixpence.  Temperature 
38*8°  to  39'i°  C. ;  respiration  28  to  30  ;  pulse  60  to  66. 

Treatment. — The  animal  was  placed  in  a  dark  box.  Milk,  gruel, 
hay,  and  oats  were  offered.  Bicarbonate  of  soda  was  added  to  the 
drinking-water.  Five  and  a  half  fluid  drachms  of  an  emulsion  pre- 
pared from  the  cerebral  substance  of  a  dog  was  subcutaneously  in- 
jected, and  two  quantities  of  two  and  a  half  and  five  fluid  drachms  of 
I  per  cent,  iodine  solution  were  injected  intra-venously.  Though  con- 
tinued from  the  6th  to  the  15th  May,  this  treatment  appeared  to  have 
no  effect  on  the  temperature,  circulation,  respiration,  or  on  the  mus- 
cular contractions.  Nevertheless,  during  the  hour  following  the  iodine 
injections  excitement  seemed  diminished. 

Next  day  there  was  no  particular  change.  The  bowels  were  con- 
stipated. Passage  of  urine  was  frequent  and  painful.  Six  and  a  half 
ounces  of  sodium  sulphate  and  four  drachms  of  bicarbonate  were  added 
to  the  drinking-water. 

On  the  7th  tension  about  the  neck  and  trismus  were  less  marked. 
Swallowing  was  easier.  Temperature  38"  1°  to  387°  C.  ;  respiration  28 
to  32  ;  pulse  60  to  66, 

On  the  8th  the  improvement  continued.  Temperature  38°  to 
38*9°  C. ;  respiration  22  to  30 ;  pulse  60  to  62. 

On  the  9th  condition  stationary.  The  patient  moved  about  its  box. 
The  eye  was  still  partly  covered  by  the  membrana  nictitans.  Tem- 
perature 38°  to  38*4°  C. ;  respiration  25  to  32  ;  pulse  60  to  64. 

From  the  loth  to  the  i8th  May  the  condition  was  more  satis- 
factory. The  symptoms  gradually  diminished.  Temperature  37*9° 
to  38*6°  C. ;  respiration  25  to  28  ;  pulse  52  to  60.  From  the  15th  only 
one  daily  injection  of  two  and  a  half  drachms  of  iodine  solution  was 
made. 

On  the  19th  May  the  iodine  treatment  was  stopped.  The  jaws 
were  moved  normally.  There  was  only  trifling  stiffness  when  moving. 
Recovery  was  assured.     The  animal  left  hospital  on  the  24th. 

Remarks. — None  of  the  drugs,  or  combination  of  drugs,  yet  sug- 
gested for  the  treatment  of  tetanus  are  of  much  value.     In  the  horse, 


TETANUS.  503 

whatever  treatment  be  adopted,  the  mortality  is  about  70  per  cent.  I 
have  made  experiments  as  to  the  benefit  of  excising  the  inoculation 
wound,  and  of  injecting  antitoxic  serum.  In  our  patient  free  removal 
of  the  margins  of  the  inoculation  wound  necessitates  anaesthesia,  with- 
out which  excessive  excitement  and  violent  struggling  occur.  It  is  of 
less  value  than  careful  disinfection  of  the  wound,  provided  this  can  be 
done  without  causing  pain. 

It  is  well  known  that  the  first  antitoxic  serums  produced  in  Ger- 
many and  France  were  useless  in  the  acute  form  of  tetanus.  They 
have  only  proved  successful  in  chronic  tetanus,  a  form  which  in  the 
horse  is  often  followed  by  recovery  under  the  older  forms  of  treatment. 

In  November,  1896,  Professor  Dieckerhoff  published  in  the  Berliner 
tliierdrztliche  WocJienschrift  some  clinical  cases  which  appeared  to  show 
that  a  new  antitoxin  (Behring's  dry  antitoxin),  manufactured  in  the 
Sero-therapeutic  Institute  of  Hochst-u.-Main,  when  subcutaneously 
or  intra-venously  injected  in  doses  of  seventy-five  grains,  dissolved  in 
eleven  and  a  quarter  drachms  of  sterilised  water,  cured  the  acute  form 
of  tetanus.  In  spite  of  the  high  price  of  the  remedy  (6s.  3^.  per  fifteen 
grains),  I  procured  a  sufficient  quantity  to  study  the  effects.  Cases 
156  and  157  were  treated  with  an  intra-venous  injection  of  seventy-five 
grains  of  this  antitoxin.  The  first  died  twenty-four  hours  after  injec- 
tion, and  the  second  on  the  fourth  day.  In  three  other  horses  affected 
with  acute  tetanus,  treated  by  subcutaneous  injections  of  an  emulsion 
of  nerve  substance,  and  by  intra-venous  injections  of  iodine  solution, 
the  course  of  the  disease  was  less  rapid  than  in  the  two  preceding 
cases,  but  the  final  result  was  the  same.  The  intra-cranial  injection 
of  antitoxic  serum  is  still  the  subject  of  study.  Its  efficacy  in  acute 
tetanus  not  having  as  yet  been  clearly  demonstrated,  it  cannot  be 
recommended  in  practice. 


VII.— VARIOUS   DISEASES. 

PARASITIC    ANEMIA    (IXODES). 

196.  A  nine-year-old  setter  dog,  entered  hospital  November  24th, 
1894.  For  several  months  this  dog  had  been  covered  with  ticks. 
More  than  300  could  be  counted,  fixed  principally  to  the  ears,  the 
right  side  of  the  head,  the  left  shoulder,  the  chest,  and  the  dorso- 
lumbar  region.  The  animal  was  thin  and  very  feeble,  showed  slight 
ptyalism,  and  its  mucous  membranes  were  pale.  Appetite  was  good. 
Temperature  37*8°  C. 

The  ticks  fixed  to  the  ears  and  left  shoulder  were  touched  with  oil 
of  turpentine,  and  those  in  the  other  regions  with  benzine.  At  the 
end  of  an  hour  some  of  the  larger  which  had  been  touched  with 
benzine  began  to  loosen  their  hold.  An  hour  later  the  majority  were 
only  attached  by  the  rostrum,  and  their  bodies  were  blackish  ;  they 
were  then  easily  removed  with  forceps.  The  large  ticks  touched  with 
oil  of  turpentine  became  detached  more  slowl3^  The  smaller  had  all 
preserved  their  colour.  At  the  end  of  four  hours  all  the  parasites, 
whether  touched  with  benzine  or  with  turpentine,  remained  fixed  to 
the  skin  only  by  the  end  of  the  rostrum. 

The  patient  showed  uneasiness  and  partial  paresis  of  the  hind 
quarters,  resulting  from  absorption  of  a  certain  quantity  of  the  agents 
employed.  It  was  washed,  dried,  and  rubbed,  and  given  a  few 
spoonfuls  of  strong  coffee  and  milk  containing  bicarbonate  of  soda. 

Some  ticks  which  survived  the  action  of  the  benzine  and  turpen- 
tine were  touched  with  pure  carbolic  acid.  At  the  end  of  ten  minutes 
they  were  easily  removed.  It  is  interesting  to  note  that  the  larger 
ticks  appeared  less  resistent  than  the  small. 

ECHINOCOCCOSIS    OF    THE    BRAIN,    LUNGS,    AND    LIVER    IN    A    HORSE. 

197.  A  fifteen-year-old  blue  roan  pony,  first  seen  at  5.30  a.m.  on 
June  3rd,  1895. 

History. — Was  thought  to  have  sustained  some  injury  to  its  hind 
quarters,  and  was  unable  to  rise. 

On  the  previous  evening  it  had  been  a  little  restless,  and  seemed 
rather  uncertain  on  its  hind  legs,  but  becoming  quieter  after  the 
administration  of  some  simple  colic  medicine  it  was  left  for  the  night. 
Early  next  morning  the  coachman  found  the  pony  lying  on  its  off  side, 
sweating  a  good  deal,  and  unable  to  rise.  It  had  been  lifted  by  sheer 
strength,  but  could  not  stand. 


ECHINOCOCCOSIS    OF   THE    BRAIN,    LUNGS,    AND    LIVER    IN    A    HORSE.         505 


State  oil  Examination. — The  animal  was  still  lying  on  its  off  side,  and 
appeared  fairly  comfortable.  The  pulse  was  50,  soft,  and  of  good 
volume  ;  respirations  16,  temperature  ioo|-°.  The  conjunctiva  was  of 
a  brick-red  tint,  and  the  pupil  sensitive  to  light. 

The  animal  was  turned  over  and  placed  in  a  position  to  rise,  but  in 
spite  of  some  assistance  it  made  no  effort  to  do  so.  Examination  of 
the  back  and  off  hind  limb  revealed  no  injury.  There  was  neither  pain 
nor  crepitation,  and  sensation  seemed  good  in  both  hind  limbs.  The 
statement  (elicited  by  close  questioning)  that  the  pony  had  not  been 
exercised  for  some  days,  but  had  been  liberally  fed,  aroused  suspicion 
of  haemoglobinuria,  although  the  lumbar  muscles  did  not  show  the 
usual  stiffness.  The  suggestion  was  afterwards  negatived  by  the  urine 
continuing  perfectly  normal. 

As  it  was  important  to  raise  the  patient,  and  allow  it,  if  able,  to 
stand,  this  was  done,  but  the  animal  failed  to  place  any  weight  on  the  off 
hind  limb,  which  seemed  para- 
lysed :  while  the  near,  though 
sustaining  weight,  could  not  be 
moved.  The  united  efforts  of 
five  men  were  required  to  keep 
the  animal  on  its  legs,  and 
therefore  after  the  bed  had  been 
renewed  and  increased  it  was 
again  let  down. 

Failing  any  positive  evidence 
to  the  contrary,  and  no  urine 
having  been  found  in  the  blad- 
der, the  case  was  at  this  stage 
treated  as  azoturia.  Stimu- 
lating applications  were  made 
to  the  loins,  and  an  anodyne 
draught  containing  Tr.  Opii  fl. 
3ss,    Chloral  Hydrate  Jj,  Spt. 

Tereb.  fl.  jss,  and  01.  Lini  Oss  administered,  and  ordered  to  be  re- 
peated in  four  hours. 

By  8  p.m.  on  the  same  day  (June  3rd)  there  was  no  particular 
improvement,  but  the  urine  having  been  examined  the  diagnosis  of 
azoturia  became  untenable.  In  the  meantime,  however,  the  pupils 
became  insensitive  to  light,  and  some  difficulty  was  shown  both  in 
breathing  and  swallowing.  Cerebral  injury  was  therefore  suspected, 
and  a  dose  of  aloes  and  calomel  given  to  unload  the  bowels.  Cold 
applications  were  made  to  the  head,  and  at  a  later  date  a  blister  was 
applied. 

At  6  p.m.  on  June  4th  the  pony  was  still  unable  to  rise,  and  lay 
with  the  head  and  neck  fully  extended.  The  pulse  was  imperceptible 
either  at  the  submaxillary  or  radial  arteries,  and  the  heart's  impulse 
could  not  be  detected  through  the  chest  wall.  The  respirations  were 
57.  The  pupil  was  fully  dilated  and  completely  insensitive  to  light  ; 
the  retinal  vessels  appeared  enlarged,  and  the  bright  reflection  from 
the  tapetum  was  dulled  by  what  seemed  to  be  a  deposit  of  lympho     A 


Fig.  65. — Region  of  insensibility  (shaded). 


5o6 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


corneal  ulcer,  the  size  of  a  split  bean,  had  developed  in  the  right  eye. 
The  mouth  was  hot  and  dry,  salivation  completely  in  abeyance. 
There  was  moderate  bilateral  paralysis  of  both  lips,  grinding  of  the 
jaws,  and  from  time  to  time  a  slight  muscular  spasm  appeared  to  flit 
over  the  face.  The  near  hind  leg  had  become  affected  almost  to  the 
same  degree  as  the  off,  but  both  still  responded  to  stimuli,  such  as  the 
prick  of  a  pin,  except  over  the  upper  part  of  each  quarter  in  the 
region  shown  in  the  diagram  (shaded).  For  the  previous  twenty- 
four  hours  the  animal  had  shown  regularly  recurring  periods  of  excite- 
ment, moving  the  legs  rapidly,  as  if  at  full  gallop,  for  a  minute  or  two, 
and  then  subsiding  into  quiet.  Latterly  the  fore-limbs  alone  had 
been  moved,  the  hind  limbs  being  partially  flexed,  and  kept  either 
quite  still  or  only  moving  passively.     Pricking   the  skin  of  the  hind 


Fig.  66.  —  Liver  with  cysts. 


limbs  at  any  point  outside  the  shaded  area  produced  an  exaggerated 
movement  of  the  panniculus,  or  in  some  cases  contraction  of  the  limb. 
That  sensation  in  the  hind  limb  was  not  entirely  destroyed,  however, 
was  shown  by  the  fact  that  a  sharp  prick  also  excited  contractions 
in  the  fore-limbs.  There  was  local  sweating  under  the  arms  and  in 
the  flank.     The  tail  was  partially  paralysed. 

The  bowels  were  acting  slightly.  The  kidneys  had  acted  twice  on 
the  3rd,  and  once  on  the  morning  of  the  4th.  Having  regard  to  the 
sudden  onset,  the  almost  total  absence  of  fever  and  of  delirium,  the 
failure  to  detect  local  injury,  and  the  rapid  course,  the  diagnosis  was 
haemorrhage  at  the  base  of  the  brain — an  opinion  that  proved  far  from 
correct.  The  prognosis  was  necessarily  very  unfavourable,  and,  in  point 
of  fact,  the  animal  died  about  9  p.m.  on  the  evening  of  the  4th  June. 


ECHINOCOCCOSIS    OF    THE    BRAIN,    LUNGS,    AND    LIVER    IN    A    HORSE. 


507 


On  post-mortem  examination,  made  the  same  evening,  the  intestines, 
spleen,  bladder,  and  kidneys  were  apparently  normal,  though,  as  would 
be  expected  in  an  old  and  well-fed  animal,  there  was  an  unusual  accu- 
mulation of  fat  around  the  kidneys  and  in  the  omentum  and  mesentery. 


Fig.  6j. — Liver,  showing  cysts,  laid  open. 

The  liver  was  enlarged,  showed  signs  of  fatty  degeneration,  and  its 
left  lobe  contained  numerous  cysts,  marked  a,  h,  c,  and  d  in  the  figure. 
These  only  represent  a  few  (Fig.  66).  A  straw  has  been  inserted  in  one 
of  the  upper  cysts  which  had  been  opened.      To  facilitate  description 


c 

b 

n 

II 

■1 

■ 

BM 

1 

Hi 

SB 

QH 

5^ 

1 

1 

^j^^^^^^H 

1 

Fig.  68.— Right  lung,  showing  cysts. 


a  further  figure  is  given,  showing  the  three  larger  cysts  {a,  b,  c,  and  d) 
laid  open  (Fig.  67).  That  marked  a  was  the  largest.  Its  walls  were 
of  the  consistency  of  cartilage,  measured  three  eighths  of  an  inch  in 
thickness,  and  were  lined  internally  with  a  light  greyish,  crapy-looking 


5o8 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


membrane.  It  contained  9  ounces  of  a  perfectly  clear  limpid  fluid, 
which  escaped  under  pressure  on  the  sac  being  incised.  Scrapings 
taken  from  this  were  microscopically  examined.  The  appearances  will 
be  described  later.  The  second  cyst  (really  consisting  of  the  cavities 
h  and  c)  was  perhaps  as  large  in  extent,  but  contained  less  fluid. 
Its  walls  were  calcified,  and  varied  in  thickness  from  a  quarter  to  half 
an  inch.  Its  lining  membrane  was  yellow,  and  covered  with  a  slimy 
muco-purulent  fluid,  while  the  bulk  of  its  contents  was  of  a  similar 
semi-purulent  character,  though  thinner  than  the  material  adhering  to 
the  walls.  The  third  cyst  was  somewhat  smaller,  and  contained  about 
5  ounces  of  fluid.  Its  walls  were  some  three  eighths  of  an  inch  in 
thickness,  but  in  all  material  respects  it  resembled  a.  The  central  lobe 
contained  another  cyst  ;  the  right  seemed  free. 

The  lungs  were  emphysematous.  They  showed  in  all  about  thirteen 
cysts  of  varying  sizes,  each  having  a  wall  of  cartilaginous  hardness, 
containing  a  clear  fluid  under  pressure,  and  exhibiting  a  greyish-white 


Fig.  69. — Debris  in  cyst  fluid,  showing  echi- 
nococcus  spines  and  buds  or  daughter 
cysts. 


Fig.  70. — Echinococcus  scolex,  intact. 


crapy  lining.  The  right  lung  is  that  represented  (see  Fig.  68).  The 
largest  cyst,  which  projected  prominently,  is  marked  a  ;  others  are 
marked  h,  c,  d,  and  e. 

A  minute  particle  scraped  from  the  wall  of  any  of  these  cysts 
showed  the  appearance  of  Fig.  6g.  Myriads  of  echinococcus  spines, 
singly  and  arranged  in  the  characteristic  saucer  forms,  float  in  the  fluid, 
together  with  secondary  and  tertiary  cysts  in  various  stages  of  develop- 
ment. A  secondary  cyst,  more  highly  magnified,  is  shown  in  Fig.  70. 
By  careful  lighting  this  was  seen  to  be  bounded  by  a  thin  cell-wall 
containing  apparently  a  glutinous  fluid.  At  the  base  was  the  crown  or 
saucer  of  echinococcus  spines  {b),  which,  on  rupture  of  the  investing 
membrane,  break  up  and  float  singly  in  the  fluid,  producing  the 
appearance  shown  in  the  preceding  figure.  Towards  the  top  were  two 
denser  bodies  (c),  apparently  undergoing  division,  while  throughout  the 
rest  of  the  free  space  were  numerous  daughter  cysts  (d)  arranged 
in  order. 

The  heart  was  enlarged,  but  otherwise  normal. 


ECHINOCOCCOSIS    OF    THE    BRAIN,    LUNGS,    AND    LIVER    IN    A    HORSE. 


509 


haemorrhage   had 
substance  of  the 


On  removing  the  brain  the  meningeal  vessels  appeared  congested, 
but  it  was  not  until  the  tissue  had  been  hardened  and  carefully  divided 
that  the  most  interesting  lesion  was  discovered.  Two  typical  cysts 
were  found  :  one  about  the  size  of  a  pigeon's  egg  in  the  upper  part  of 
the  cerebellum,  rather  inclined  towards  the  left  side  ;  the  other,  some- 
what smaller,  in  the  cerebrum.  In  both  cases 
occurred  around  the  cyst,  and  had  infiltrated  the 
brain. 

The  cerebellar  cyst  had  a  distinct  wall  about  one  twentieth  of  an 
inch  in  thickness,  was  lined  by  a  greyish-white  membrane,  and  con- 
tained a  yellowish  caseous  material,  examination  of  which  showed  the 
usual  echinococcus  spines.  Around  the  cyst  and  extending  obhquely 
downwards  and  forwards  towards  the  fourth  ventricle  was  a  well- 
marked  haemorrhage  (see  Fig.  71).  The  cyst  in  the  cerebrum  appeared 
of  later  growth.  Its  wall  was  thinner  and  only  perceptible  with  diffi- 
culty. It  contained  a  similar  material,  and  was  equally  surrounded  by 
a  hsemorrhagic  area,  which  in  this  case,  however,  extended  chiefly 
upwards  towards  the  point  where  the  crucial  fissure  abuts  on  the  third 
anterior  convolution. 

Note. — The  cysts  in  the  brain  and  cerebellum  were  apparently  of 


Fig.  71. — Brain,  showing  cysts. 


considerable  age,  probably  not  less  than  two  or  three  years,  and  pos- 
sibly much  older.  That  in  the  cerebellum  might  have  existed  for  five 
or  six  years,  and  provided  its  growth  were  slow  have  caused  no  peculiar 
symptoms.  Extensive  tracts  of  the  cerebellum  can  be  destroyed  by 
malignant  growths  without  interfering  with  even  the  most  complicated 
acts  ;  and  it  is  known  that  in  dogs,  large  portions  of  whose  cerebellum 
have  been  experimentally  removed,  function  is  sometimes  completely 
restored  after  the  lapse  of  a  year  or  two.  It  need  excite  no  surprise, 
therefore,  that  slowly  increasing  cysts  in  this  region  produced  no  sym- 
ptoms calling  for  remark. 

Cysts,  however,  like  tumours,  are  always  surrounded  by  a  network 
of  vessels,  the  walls  of  which  are  generally  very  thin,  and  which  in  an 
old  horse  would  be  liable  to  rupture.  A  simple  shock,  such  as  that  of 
falling  down  when  asleep,  might  produce  this  effect,  especially  if  there 
were  a  tendency  to  brain  congestion,  as  occurs  in  acute  indigestion. 
(It  must  be  remembered  the  horse  had  shown  colic  the  evening  before.) 


510  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

Haemorrhage  might  then  have  occurred  on  the  left  side  in  and  around 
the  motor  tract  for  the  hind  hmb,  finally  leading  to  more  and  more 
complete  paralysis  of  the  hind  limb  of  the  opposite  (right)  side. 
Extending  still  further,  it  would  first  produce  irritation,  and  later 
paralysis  of  the  motor  fibres  going  to  the  fore-limb,  and  then  of  those 
supplying  the  face.  It  is  somewhat  difficult  to  understand  the  partial 
paralysis  of  the  lips  while  the  fore-limbs  still  retained  their  function, 
but  the  difficulty  does  not  altogether  invalidate  the  explanation. 

Mr.  Jno.  A.  W.  Dollar's  case,  Veterinarian,  1895,  p.  775. 

PARESIS    OF    THE    HIND    LIMBS    (CHOREA). 

ig8.  A  two-year-old  poodle,  entered  hospital  August  22nd,  1897. 
On  the  18th  August  the  animal's  walk  appeared  awkward  ;  the  hind 
parts  rolled  from  side  to  side,  the  hind  limbs  being  in  fact  partially 
paralysed.  In  addition  spasms  occurred  about  the  face,  ear,  and 
shoulder,  and  discharge  from  the  eye  and  prepuce  had  been  noted. 
The  owner  did  not  think  the  dog  had  suffered  from  distemper,  but  the 
existing  symptoms  were  certainly  a  consequence  of  that  disease. 

State  on  Examination. — The  animal  was  thin.  On  clinical  examina- 
tion the  most  striking  peculiarity  was  the  weakness  of  the  hind 
quarters  ;  during  movement  the  limbs  partially  collapsed.  The 
muscles  of  the  head — especially  the  temporal  muscles — and  those  of 
the  ear,  shoulder,  and  forearm  were  the  seat  of  very  marked  clonic 
contractions.  Appetite  was  good,  but  the  animal  had  a  little  difficulty 
in  grasping  its  food.  There  was  no  cutaneous  eruption,  and  the  chief 
functions  were  normal. 

Treatment. — Administration  of  5  grains  of  potassium  iodide ;  hypo- 
dermic injection  of  "03  grain  arseniate  of  strychnine  ;  application  of  the 
faradic  current  by  means  of  brass  wires  passed  under  the  skin  of  the 
shoulder  and  of  the  base  of  the  tail  respectively.  The  current  was 
continued  for  three  to  five  minutes. 

During  the  first  four  or  five  days  the  hypodermic  injection  of  strych- 
nine was  followed  by  a  period  of  excitement,  and  by  slight  generalised 
contractions.  At  the  end  of  a  week  the  effects  became  less  marked  and 
the  contractions  feebler.  The  daily  dose  was  then  increased  by  '004 
grain,  until  a  total  daily  dose  of  '045  grain  was  reached.  In  this  dose 
the  action  of  the  strychnine  was  always  vvell  marked,  all  the  anterior 
portion  of  the  body  showing  clearly  marked  hyperaesthesia,  and  the 
slightest  touch  producing  excessive  excitability. 

Continued  for  six  weeks  this  treatment  gave  excellent  results.  The 
paralysis  of  the  hind  quarters  and  the  clonic  contractions  gradually 
diminished.  On  the  20th  September  recovery  was  almost  complete. 
Slight  spasms  still  occurred  about  the  shoulder,  but  afterwards 
entirely  disappeared. 

Remark. — In  the  treatment  of  paraplegia  following  distemper  the 
medicines  which  have  given  the  best  results  in  my  hands  are  potassium 
iodide,  given  by  the  mouth,  and  arseniate  of  strychnine  injected  subcu- 
taneously.  Very  small  doses  are  first  given,  and  are  gradually  increased 
until  the  desired  effect  is  obtained.     I  have  also  tried  this  treatment  on 


RHEUMATISM.  51I 

three  pure-bred  animals  affected  with  chorea,  a  disease  whose  nature  is 
still  undetermined,  but  which  certainly  shows  all  the  characters  of 
chronic  myelitis  of  toxi-infectious  origin.  It  did  not  produce  any 
appreciable  result.  At  the  present  time  we  have  in  hospital  a  two-year- 
old  thoroughbred  dog  affected  with  this  disease,  which  we  have  unsuc- 
cessfully treated  for  the  past  three  months  with  subcutaneous  injections 
of  cerebral  substance  and  intra- venous  injections  of  iodine. 

RHEUMATISM. 

igg.  A  ten-year-old  Danish  dog,  brought  for  examination  September 
30th,  1894. 

For  several  years  this  dog  had  shown  repeated  symptoms  of 
muscular  rheumatism — difficulty  in  moving,  stiffness  of  the  neck,  back, 
and  lim.bs.  At  certain  times  it  suffered  such  pain  as  to  howl  loudly, 
especially  at  night,  or  when  it  rose  after  having  remained  long  in  one 
position.  It  was  in  the  habit  of  bathing  in  a  running  stream  near  its 
owner's  house,  and  the  attacks  frequently  followed  these  baths. 

Except  for  these  rheumatic  attacks  the  dog  had  enjoyed  fairly  good 
health.  Five  or  six  days  before,  more  serious  troubles,  however,  had 
been  noted.  The  animal  refused  food,  remained  continually  lying  down, 
and  had  frequent  attacks  of  dry  cough.  If  forced  to  walk,  it  rolled 
from  side  to  side,  and  ended  by  falling.  These  troubles  continued, 
though  in  less  degree  than  at  first. 

When  the  animal  was  brought  here  it  showed  stiffness  in  movement, 
especially  of  the  head  and  neck  ;  the  neck  was  tense  and  rigid,  and 
seemed  painful  even  on  slight  pressure.  The  heart  revealed  a  double 
systolic  and  diastolic  murmur. 

We  prescribed  general  h3'gienic  treatment,  together  with  internal 
administration  of  i^  drachms  of  sodium  bicarbonate  and  15  grains  of 
sodium  salicylate.  During  the  night  and  next  day  the  condition 
remained  stationary. 

On  the  2nd  October  the  patient  was  found  dead  in  its  kennel. 
The  owner  sent  the  body  to  the  school  ior post-tnorteni  examination. 

Autopsy. — No  liquid  in  the  abdominal  cavity  ;  intestines  of  normal 
aspect ;  gastro-intestinal  mucous  membrane  slightly  hyperaemic  at 
points  ;  liver  enormous  and  blackish,  with  the  appearances  of  "  cardiac  " 
liver ;  the  spleen  exhibited  several  blackish  swellings,  the  largest  the 
size  of  a  nut ;  both  kidneys  were  reddish,  and  their  surface  was 
marbled  ;  sections  showed  lesions  of  chronic  nephritis. 

The  right  testicle  was  the  size  of  a  hen's  egg,  and  contained  a 
tumour  ;  the  spermatic  cord  and  the  sublumbar  lymphatic  glands  were 
invaded. 

The  lungs  contained  numerous  little  whitish  cancerous  patches. 
The  pericardium  was  normal.  The  heart  was  very  large,  marbled  with 
greyish  irregular  patches,  indicating  areas  of  indurative  myocarditis. 
The  left  heart  showed  lesions  of  chronic  endocarditis  ;  the  mitral  valves 
were  thickened,  contracted,  fibrous  at  their  base,  reddish  and  vege- 
tating towards  their  free  margins ;  the  aortic  valves  were  thickened  and 
contracted.     The  right  heart  was  less  changed,  though  the  ventricle 


512  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

was  dilated  ;  the  lips  of  the  tricuspid  valves  were  thickened  and 
reddish,  and  their  free  margins  granulating. 

The  cerebro-spinal  fluid  was  abundant.  The  meninges  lining  the 
cranium  and  covering  the  brain  showed  no  change ;  in  the  cervical 
region,  however,  they  showed  patches  of  ossification  ;  throughout  the 
rest  of  their  extent  they  appeared  normal,  as  did  the  cord. 

The  muscles  of  the  neck  were  hyperasmic,  infiltrated,  and  marked 
with  a  few  ecchymoses.     The  articulations  were  unaffected. 

Toxicological  examination  discovered  no  poison  in  the  organs. 

The  tumour  in  the  testicle  and  those  in  the  lungs  were  alveolar 
epitheliomata. 

This  case  is  interesting  for  more  than  one  reason.  It  shows  that  a 
case  which  for  years  exhibits  signs  of  rheumatism  may  end  by  contracting 
cancer ;  it  shows  lesions  of  rheumatism  and  of  ossifying  pachy- 
meningitis associated,  and  leads  us  to  ask  whether  these  latter  were  not 
the  effect  of  a  localised  rheumatic  inflammation  of  the  meninges. 

RHEUMATISM    OR    PACHYMENINGITIS? 

200.  "  Marquis,"  a  six-year-old  dog,  left  in  the  surgical  laboratory 
on  the  15th  January,  1892. 

The  condition  from  which  it  was  suffering  had  suddenly  appeared 
two  months  before.  Without  apparent  cause  the  animal  was  attacked 
with  paroxysms  of  acute  pain,  during  which  it  whined  and  sometimes 
howled  loudly.  Several  attacks  occurred  during  the  first  day.  In  spite 
of  treatment  being  commenced  on  the  second  day  these  attacks 
returned  more  or  less  frequently  and  violently.  The  dog  had  previously 
been  in  excellent  health,  and  had  always  seemed  very  intelligent,  bright, 
and  affectionate.  It  was  fed  on  cooked  meat,  which  it  ate  with  good 
appetite.  We  were  informed  that  it  had  always  shown  marked  sexual 
instinct,  continually  running  after  females  and  even  males  of  its  own 
species,  and  attempting  coitus. 

A  preliminary  examination  only  showed  somewhat  marked  double 
exophthalmia.  Left  at  liberty  in  the  laboratory  it  repeatedly  mani- 
fested signs  of  excessive  sexual  excitement ;  the  propensity  to  coitus 
appeared  almost  permanent  during  the  intervals  between  attacks.  Some- 
times these  occurred  suddenly ;  sometimes  they  were  preceded  by 
warning  symptoms,  like  dulness,  stiffness  of  the  limbs,  arching  of  the 
back  and  fixity  of  attitude,  the  head  being  depressed  and  the  nose 
almost  brought  in  contact  with  the  ground.  The  attacks,  whether  or 
not  preceded  by  preliminary  signs,  were  always  very  violent.  The 
animal  suddenly  appeared  to  be  in  acute  pain.  Standing  upright,  with 
the  head  and  neck  extended,  all  four  limbs  stiff,  or  one  of  the  front 
limbs  flexed — most  frequently  the  left  (Fig.  y^), — he  gave  vent  for  half 
a  minute  to  a  minute  to  piercing  howls,  which  were  followed  by  pro- 
longed whimpering.  Sometimes  several  attacks  succeeded  one  another, 
but  the  first  was  always  the  strongest  and  most  prolonged.  At  times 
these  attacks  could  be  produced  by  forcing  the  animal  to  move ;  some- 
times by  simply  touching  certain  regions,  which  appeared  hyperaesthetic. 
To  bring  them  on  it  was  only  necessary  to  place  the  hand  on  the 


RHEUMATISM    OR    PACHYMENINGITIS  ? 


513 


animal's  head,  neck,  or  shoulder ;  to  pass  it  over  the  back  and  loins  ; 
or  to  lift  the  animal  by  its  front  legs.  The  attacks  also  occurred  if  the 
sense-organs  were  suddenly  stimulated  as  b}'  opening  or  closing  a  door, 
or  by  letting  fall  any  metallic  object.  Sometimes  they  came  on  without 
any  appreciable  cause.  They  were  followed  by  a  prolonged  uneasy 
period.  They  also  occurred  during  the  night  :  on  certain  mornings  the 
animal  was  found  depressed,  with  the  appearance  of  having  gone 
through  a  series  of  attacks. 

During  its  bad  days  the  patient  was  not  comfortable  anywhere. 


Fig.  72. — Attitude  when  quiescent. 

Whether  lying  on  its  bed  or  sitting  up  it  seemed  to  suffer  extremely. 
The  body  showed  slight  trembling  ;  the  face  was  anxious  ;  the  eyes 
even  more  prominent  than  usual ;  the  respiration  moaning.  When 
standing  upright  the  back  was  strongly  arched  ;  the  limbs  were  placed 
far  in  advance  of  their  ordinary  position  ;  the  body  was  rocked  slightly 
from  behind  forwards  ;  the  neck  was  tense,  and  the  head  depressed. 
The  least  movement  produced  cries.  If  the  animal  lay  down  it  did  so 
with  great  precautions.  First  of  all  it  sat  down  slowly,  extended  the 
front  limbs,  then  rolled  gently  over  on  one  or  other  side. 

On  the  29th   February,  1892,  the  attacks  were  particularly  severe. 

K  K 


514 


CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 


The  first  was  produced  by  a  very  trifling  blow  on  the  neck.  The 
animal  was  still  standing  stiflly,  with  the  back  arched  and  the  front 
limbs  extended,  when  a  second  attack  was  determined  by  the  noise  of  a 
metal  box  falling  on  the  floor.  A  few  minutes  later,  when  it  was 
about  to  lie  down,  still  whimpering,  a  third  attack  followed  without  any 
appreciable  external  cause.  During  the  night  others  occurred,  but  less 
frequently  than  at  first. 

In  spite  of  these  frequent  crises  the  animal  remained  well  nourished. 
During  the  intervals,  and  sometimes  during  several  days  together,  it 
was  bright  and  cheerful,  ate  well,  and,  as  stated  above,  appeared 
desirous  of  coitus.  Its  intelligence  was  in  no  way  impaired.  The 
temperature  was  normal ;  the  sensibility  of  the  skin   was  not  lessened 


Fig.  73. — Attitude  dviring  an  attack. 

at  any  point ;  the  reflexes  were  preserved  ;  there  was  no  ocular  dis- 
turbance or  apparent  disease  of  the  ears. 

This  condition  continued  without  notable  change  until  the  25th 
March,  when  recovery  occurred.  On  the  28th  March  a  small  bitch  in 
heat  was  brought  into  the  laboratory.  "  Marquis,"  who  had  to  be 
fastened  up  to  prevent  his  troubling  her,  made  a  scene  at  the  door  of 
the  room  where  she  was.  For  hours  he  ran  to  and  fro  in  the  rooms 
through  which  she  had  passed,  searching  for  her,  jumping  on  tables, 
and  looking  through  windows.  In  spite  of  this  prolonged  excitement 
no  fit  occurred. 

After  being  castrated  in  March,  1894,  this  dog  became  eczematous 
and  fat.  He  continued  at  liberty  in  the  surgical  hospital  until  May, 
1897.  Having  been  taken  out  one  Sunday  by  the  attendant  in  my 
hospital,  whom  he  was  in  the  habit  of  accompanying,  he  took  advan- 
tage of  a  crowd  to  escape,  and  was  never  again  found. 


SARCOMATOUS    DISEASE    OF   THE    LUNG.  515 

What  was  the  nature  of  this  disease,  which  continued  for  nearly 
five  months  producing  these  painful  crises  ?  Our  diagnosis  always 
hesitated  between  rheumatism  and  pachymeningitis.  I  have  seen 
several  other  patients  suffering  from  similar  though  less  violent  and 
less  persistent  attacks,  due  to  rheumatism.  I  incline  to  think  that  in 
this  dog  a  rheumatic  localisation  had  occurred  in  the  meninges  and 
auditory  apparatus.  The  hypothesis  of  ossifying  pachymeningitis  is 
scarcely  compatible  with  the  perfect  and  lasting  recovery. 

SARCOMATOUS     DISEASE    OF    THE    LUNG. 

201.  A  fifteen-year-old  entire  horse,  entered  hospital  June  ist, 
1897.  For  two  years  previously  this  horse  had  enjoyed  good  health. 
The  sides  of  the  chest  were  marked  by  hairless  patches  due  to  long- 
previous  blistering.  On  the  25th  May  the  animal  experienced  a  chill 
and  showed  some  alarming  symptoms,  regarded  as  due  to  broncho- 
pneumonia. 

State  on  Examination. — On  the  day  of  entering  hospital  the  patieiit 
exhibited  evident  signs  of  grave  disease  ;  the  mucous  membranes  were 
injected  and  slightly  swollen  ;  the  respiration  was  very  rapid  (50  per 
minute)  ;  cough  readily  followed  pressure  on  the  larynx,  and  was  loud, 
moist,  and  inclined  to  recur  ;  there  was  abundant  mucous  discharge, 
which  contained  numerous  organisms,  among  others  an  encapsuled 
diplococcus,  which  stained  by  Gram's  method.  Nothing  abnormal 
was  noted  on  percussing  the  chest.  On  auscultation  the  vesicular 
murmur  could  be  detected  over  the  entire  area  of  both  pulmonary 
lobes.  The  heart  was  normal,  the  pulse  accelerated  {yo  per 
minute).  The  appetite  was  good,  the  animal  ate  all  its  food ;  the 
faeces  were  normal.  Temperature  40*8°  C.  The  cough,  discharge, 
difficulty  in  respiration,  and  coloration  of  the  mucous  membranes 
appeared  to  indicate  that  the  animal  was  suffering  from  pneumonia, 
still  localised  in  the  deep  parts  of  one  or  both  lungs. 

Treatment. — Sulphate  of  quinine,  and  sulphate  and  bicarbonate  of 
soda  internally ;  fumigations  with  menthol  (produced  by  adding  a 
tablespoonful  of  the  following  mixture  to  half  a  bucket  of  hot  water : 

Menthol  ....  10  drachms. 
Oil  of  turpentine  .  .  10  drachms. 
Alcohol       ....         izh  ounces.) 

From  the  2nd  to  the  14th  June  little  change  occurred.  The  per- 
sistence of  fever,  cough,  and  dyspnoea,  and  the  signs  furnished  by  aus- 
cultation and  percussion,  led  us  to  diagnose  chronic  pneumonia  with 
abscess  formation  in  the  lung,  or  tuberculosis.  The  fumigations  were 
stopped.  Nothing  abnormal  was  found  on  rectal  examination.  The 
discharge  contained  no  tubercle  bacilli.  The  urine  was  highly  charged 
with  deposit  and  was, slightly  alkaline,  but  showed  no  epithelial  casts, 
or  sugar,  and  very  little  albumen.  The  reaction  for  indican  was 
doubtful. 

On  the  15th  June  the  chest  was  punctured,  with  the  hope  of  obtain- 
ing a  little  pleural  liquid  for  examination  ;  nothing  escaped. 


5l6  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

The  temperature  continuing  at  40°  C,  the  animal  could  not  be 
tested  with  tuberculin. 

Until  the  25th  June  the  condition  slowly  grew  worse  ;  wasting  and 
weakness  became  more  marked.  Respiration  was  greatly  accelerated 
and  painful.  Percussion  indicated  dulness  at  several  points.  On  aus- 
cultation the  vesicular  murmur  was  diminished  over  the  entire  extent 
of  both  lobes,  and  various  abnormal  sounds  were  heard,  particularly 
crepitant  rales  towards  the  end  of  expiration. 

On  the  28th  June  the  animal  was  slaughtered. 

Lesions. — The  abdominal  organs  appeared  normal,  but  on  opening 
the  chest  the  surfaces  of  the  lung  appeared  mammilated  and  bosse- 
lated  by  greyish  tumours.  Sections  exhibited  a  bright  red  ground 
formed  by  the  healthy  pulmonary  tissue,  marked  with  circular,  sharply 
defined,  whitish  patches,  varying  in  size  between  a  sixpence  and  a 
man's  hand,  resulting  from  division  of  the  tumours.  The  lungs 
weighed  thirty-four  pounds.  The  bronchial  glands  were  only  slightly 
hypertrophied. 

The  pleural  cavity  and  heart  were  normal. 

On  microscopic  examination  the  tumours  showed  the  characters  of 
round-celled  sarcoma ;  but  bacteriological  examination  was  carried  out 
in  order  to  dispose  of  the  question  of  tuberculosis.  Numerous 
sections  were  made,  but  no  bacilli  found.  Four  guinea-pigs  were  intra- 
peritoneally  injected  with  an  emulsion  formed  by  crushing  fragments 
of  the  pulmonary  tumour  in  sterilised  water.  When  killed  five  weeks 
later  they  showed  neither  tuberculous  nor  sarcomatous  lesions. 

These  pulmonary  tumours  had  the  same  naked-eye  appearances  as 
the  lesions  in  the  sarcomatous  form  of  tuberculosis,  from  which  they 
conld  only  be  satisfactorily  differentiated  by  bacteriological  examina- 
tion and  inoculation. 

ROUND-CELLED     SARCOMA    OF    THE    RIGHT    TESTICLE    WITH 
ENORMOUS    INTRA-ABDOMINAL    TUMOUR    IN    A    HORSE. 

202.  Sixteen-year-old  black  cart-horse  ;  a  right  monorchid. 

History. — The  animal  had  been  in  the  possession  of  a  carrier  for 
twelve  years,  was  noted  for  its  great  endurance,  and  had  never  shown 
signs  of  illness  prior  to  the  last  week  of  December,  1893. 

State  on  Examination.  —  Haggard  expression  of  countenance ; 
animal  stood  with  fore  and  hind  legs  widely  abducted,  and  showed  great 
disinclination  to  move.  Temperature  105°  F. ;  pulse  65.  Appetite 
fastidious  ;  bowels  costive.  On  careful  search  a  large  tumour  was 
found  in  the  right  scrotal  sac ;  it  extended  to  the  external  abdominal 
ring,  was  very  firm  and  non-sensitive.  A  dose  of  physic  was  given, 
and  acted  freely.  On  rectal  examination  on  the  following  day  an 
enormous  abdominal  tumour  was  discovered,  occupying  the  right 
lumbar  region,  extending  forwards  to  the  right  kidney,  backwards  into 
the  pelvic  cavity,  and  downwards  to  the  floor  of  the  abdomen.  It  was 
firmly  attached  to  the  inferior  surface  of  the  rectum. 

Prognosis  was  unfavourable. 

From  this  time  onwards  the  animal  became  gradually  weaker ;  the 


MAMMARY    ADENOMA    IN    THE    BITCH    WITH    PULMONARY    METASTASIS.       517 

right  limb  from  the  haunch  downwards  became  greatly  swollen,  as  did 
the  sheath  and  subcutaneous  connective  tissue  under  the  abdomen. 

The  horse  was  killed  on  the  17th  January,  the  autopsy  revealing 
the  above-described  tumour,  which  weighed  fifty  pounds.  There  was 
evidence  of  chronic  peritonitis  ;  the  abdomen  contained  several  gallons 
of  sanguineous  fluid ;  all  the  abdominal  and  thoracic  organs  were 
healthy. 

Microscopical  examination  showed  the  growth  to  be  a  round-celled 
sarcoma. 

The  testicle  was  soft  and  pulpy ;  all  the  testicular  substance  ap- 
peared to  have  been  destroyed ;  the  structure  of  the  cord  up  to  the 
point  of  junction  with  the  abdominal  tumour  was  normal.  The  abdo- 
minal growth  was  for  the  most  part  firm,  glistening  on  section,  and 
here  and  there  showed  evidence  of  haemorrhagic  infiltration. 

Prof.  Walley's  case,  Journ.  Comp.  Path,  and  Therap.,  1894,  p.  66. 

CARCINOMA    OF    THE    KIDNEY    IN    A    HORSE. 

203.  An  eight-year-old  half-bred  bay  gelding. 

History. — Four  months  before  examination  the  animal  seemed  to  be 
easily  fatigued,  and  had  fallen  away  in  condition.  When  turned  out 
to  grass  it  wasted  rapidly,  and  swellings  appeared  under  the  belly,  in 
the  sheath  and  hind  limbs.  On  the  right  side  the  asternal  ribs  were 
outwardly  displaced,  apparently  by  some  abdominal  growth.  Pulse 
50,  weak  ;  temperature  ioi°  F.  During  the  subsequent  stages  the 
temperature  varied  between  ioi°  and  104°  F. 

Diagnosis. — Enlarged  liver. 

Slaughter  was  advised,  but  a  delay  of  some  weeks  occurred  before 
the  advice  was  put  in  practice. 

Post-mortem  examination  showed  the  right  kidney  to  be  enormously 
enlarged.  It  was  attached  above  to  the  psose  muscles,  on  the  right 
to  the  abdominal  wall,  and  below  to  the  double  colon.  Before  incision 
it  weighed  seventy-nine  pounds,  and  measured  four  feet  six  inches  in 
circumference.  The  left  kidney  was  nearly  double  its  ordinary  size, 
but  otherwise  normal. 

Microscopical  examination  showed  that  the  mass  was  almost  entirely 
composed  of  a  carcinomatous  new  growth,  with  a  small  amount  of 
stroma  and  epithelial  cells  of  the  spheroidal  or  glandular  type. 

Mr.  G.  J.  Harvey's  case,  Joitrii.  Comp.  Path,  and  Therap.,  1892,  p.  378. 

MAMMARY    ADENOMA    IN    THE    BITCH    WITH    PULMONARY 
METASTASIS. 

204.  A  collie  bitch  suffering  from  a  tumour  about  the  size  of  a 
hen's  egg  in  the  mammary  gland.  Removal  was  not  attempted.  The 
patient  had  been  unwell  for  about  a  week,  but  dyspnoea  only  appeared 
two  or  three  days  before  death,  and  did  not  become  distressing  until 
twenty-four  hours  before  the  end. 

On  autopsy  both  lungs  were  found  to  be  enlarged,  and  did  not 
collapse  on  opening  the  chest.     The  surface  of  the  visceral  pleura  was 


5l8  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

raised  by  a  multitude  of  small  greyish  nodules  varying  in  size  from  a 
pea  to  a  hazel-nut. 

On  section  these  nodules  were  found  throughout  the  lung  sepa- 
rated by  a  very  small  but  variable  amount  of  lung  tissue.  Their 
consistence  was  that  of  a  hepatised  area  in  the  horse  ;  the  invaded 
parts  were  airless  and  contained  no  softened  centres.  The  bronchial 
glands  were  enlarged  and  firmer  than  normal ;  some  contained  black 
pigmented  centres  (carbon). 

205.  A  setter  bitch  with  tumour  about  the  size  of  a  man's  fist,  which 
was  excised.  The  patient  remained  dull  after  operation,  but  no  definite 
symptoms  appeared  until  the  tenth  day,  when  the  temperature  rose  to 
105°  F.,  and  the  respirations  became  slightly  hurried.  The  temperature 
gradually  rose  to  106°  F.,  the  symptoms  of  dyspnoea  became  more 
intense,  and  on  the  fourteenth  day  the  patient  died.  The  microscopic 
appearance  of  the  lungs  of  this  animal  was  practically  the  same  as  in 
Case  204.  The  nodules,  however,  were  hardly  so  numerous,  nor  were 
they  as  firm  ;  their  consistence  was  that  of  a  normal  testicle. 

The  microscopical  appearance  was  the  same  in  both  cases,  and  sug- 
gestive of  what  ma}'  follow  from  an  infecting  agent  being  arrested  in 
the  pulmonary  capillaries.  At  various  points  the  spongy  tissue  was 
obliterated  by  very  dense  collections  of  oval-shaped  cells  resembling 
certain  forms  of  glandular  epithelium,  but  only  in  a  few  cases  was  there 
an  acinal  arrangement.  Each  cellular  area  was  surrounded  by  a 
limiting  membrane,  which  was  not  of  the  same  thickness  in  every  case. 
In  some  cases  this  membrane  was  the  alveolar  wall,  in  others  the  inter- 
lobular septum  ;  in  the  latter  case  the  interfibrous  spaces  were  invaded 
and  the  fibrous  tissue  cells  were  proliferating.  The  majority  of  the 
cells  had  a  diameter  of  5  ^ ;  a  few  were  somewhat  larger.  The  seg- 
mentation of  their  nuclei  indicated  the  activity  with  which  they  were 
dividing.  In  the  more  open  parts  the  alveolar  walls  were  thickened, 
and  their  cavities  contained  a  few  catarrhal  cells.  The  new  formations 
in  the  bronchial  glands  were  identical  in  structure  with  those  in  the 
lungs. 

Note. — Adenomata  are  the  commonest  malignant  neoplasms  in  the 
bitch,  and  their  primary  seat  is  usually  in  the  mammary  gland.  The 
two  cases  just  described  show  in  how  astonishingly  short  a  time  the 
secondary  (metastatic)  growths  may  develop  ;  they  give  an  idea  of 
when  symptoms  of  secondary  formation  may  be  expected  after  operation, 
or  in  other  words  at  what  date  after  operation  a  favourable  prognosis 
may  be  ventured  on.  In  both  cases  symptoms  of  dyspnoea  only 
occurred  a  few  days  before  death,  in  Case  205  on  the  tenth  day 
after  that  on  which  we  might  assume  the  infecting  agent  gained  the 
venous  stream.  During  this  time  the  new  cells  were  actively  dividing 
and  obliterating  the  lung  tissue,  which  on  the  fourteenth  day  was  so  far 
destroyed  as  to  render  life  impossible.  As  the  primary  lesion  was  in 
the  mammary  gland,  and  the  secondary  growths  in  the  lungs  and 
bronchial  glands,  it  is  probable  that  the  infecting  agent  travels  both  by 
the  venous  and  lymph  streams. 

Prof.  Stockman's  cases,  Journ.  Coinp.  Path,  and  Therap.,  1895,  p.  254. 


INFECTIVK    GRANULOMA    IN    A    MARE. 


SI9 


INFECTIVE    GRANULOMA    IN    A    MARE. 

206.  Ten-year-old  bay  cob  mare. 

History. — About  the  beginning  of  1899  the  animal  showed  inconti- 
nence of  urine,  which  continued  for  a  time  without  improvement. 

A  local  adviser  was  called  in,  who  prescribed,  and  the  animal 
seemed  to  recover  somewhat,  but  symptoms  recurred  soon  afterwards. 
Naturally  the  almost  continuous  urination  caused  irritation  and 
inflammation  of  the  skin  of  the  thighs,  and  ultimately  developed  raw 
sores.  There  was  also  a  difficulty  experienced  in  defecation.  Gradual 
atrophy  was  observed  to  occur  on  the  right  side  of  the  back  behind  the 


Fig.  74. — Malignant  granuloma.      Mare:   section  of  stomach,     (fin.  obj. 
camera  length  iSin.) 


withers,  just  underneath  the  seat  of  the  saddle,  for  a  period  of  six  to 
eight  months  before  death.  At  last  the  owner  had  the  animal  slaugh- 
tered. 

Post-mortem  Examination.—"  The  animal  was  in  poor  condition. 
The  pulmonary  pleura  was  thickened  and  indurated,  while  large 
patches  of  the  lung  beneath  were  firm,  very  dense  to  the  touch,  and 
almost  cartilaginous  on  section.  The  growth  was  in  large  areas,  lying 
more  or  less  underneath  the  pleura,  and  the  inferior  border  of  the  lung, 
bronchi,  and  blood-vessels  showed  thickening  to  a  great  extent,  while 
here  and  there  in  the  diseased  area  small  caseous  nodules  were  discern- 


523  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

ible.  The  thoracic  lymphatic  glands  were  apparently  not  affected. 
The  liver  contained  large  whitish  fibrous  areas  scattered  throughout  its 
substance,  and  the  diaphragm  had  attached  to  its  posterior  surface  a 
number  of  yellowish  nodules  about  the  size  of  a  pea.  The  wall  of  the 
stomach  was  very  much  indurated,  being  at  places  about  an  inch  thick 
from  the  mucous  to  the  peritoneal  surface,  and  composed  of  hard, 
dense,  fibrous  growth,  showing  on  section  here  and  there  small  caseous 
foci,  from  the  size  of  a  pin's  head  to  that  of  a  wheat  seed.  The  internal 
mucous  surface  was  inflamed,  and  felt  tough.    The  portion  of  the  organ 


Fig.  75 — Malignant  granuloma.     Mare:  section  of  lung  showing  cirrhosis, 
periarteritis,  peribronchitis,  and  distended  lymph  spaces. 


affected  was  chiefly  the  greater  curvature.  The  supra-renal  bodies  were 
enlarged.  The  ovaries  were  very  much  enlarged,  and  of  the  same  dense 
fibrous  consistency  as  the  other  organs  affected.  The  walls  of  the 
uterus  and  of  the  bladder  were  also  thickened  and  cedematous,  the 
mucous  surfaces  being  inflamed  and  raw-looking.  The  bladder  con- 
tained a  quantity  of  blood-coloured  foetid  urine  and  a  considerable 
quantity  of  calcareous  deposit,  the  mucous  membrane  being  inflamed 
and  haemorrhagic."  Specimens  of  the  different  organs  were  preserved 
in  a  solution  of  "  formalin."     The  pathological  changes  were  evidently 


INFECTIVE    (iRANULOMA    IN    A    MARE.  52 1 

due  to  the  growth  of  new  fibrous  tissue,  which  was  of  a  dense  nature, 
feehng  almost  Hke  hard  india  rubber,  and  of  a  pecuhar  dirty  yellow 
colour. 

Sections  were  made  of  various  portions  of  the  different  organs,  and 
the  new  growths  ascertained  to  be  composed  of  dense  fibrous  tissue. 
The  appended  photographs  show  the  microscopical  appearance  of  the 
lung  and  stomach.  At  first  the  case  was  regarded  as  due  to  actinomyces 
or  botryomyces  ;  but,  although  sections  were  stained  by  every  conceiv- 
able method,  Mr.  Gilruth  failed  to  demonstrate  to  his  own  satisfaction 
any  organism  that  might  be  looked  upon  as  the  cause  of  this  peculiar 
condition.  The  caseous  foci,  where  sections  were  stained  with  carbol- 
fuchsin  and  decolourised  with  picric  acid,  showed  a  few  small  points 
which  retained  the  red  stain,  but  it  was  doubtful  whether  these  were 
even  parasitic  in  nature. 

In  the  photograph  of  the  lung  the  intensity  of  the  periarteritis  and 
peribronchitis  will  be  observed,  as  also  the  sharp  line  of  demarcation 
between  the  fairly  healthy  and  diseased  tissue ;  and  in  that  of  the 
stomach  the  spread  of  the  round-cells  between  the  altered  gastric 
glands,  with  the  dense  fibrous  tissue  underneath,  will  be  noted  with 
interest. 

Mr.  J.  A.  Gilruth's  case,  Veterinarian,  1900,  p.  298. 


PART     IV. 

EXPERIMENTAL     AND     COMPARATIVE 
PATHOLOGY. 


L— A    CONTRIBUTION    TO    THE    STUDY    OF    AVIAN 
TUBERCULOSIS. 

(In  collaboration  with  MM .  Gilbert  and  Roger,  Fello^us  of  the  Paris  Faculty  of  Medicine, 

Doctors  of  Medicine.) 

I.— HISTORICAL. 

Numerous  memoirs  published  during  the  last  thirty  years  have 
shown  that  tuberculosis  is  common  in  birds.  Leisering,  Larcher, 
Paulicki,  Ziirn,  and  certain  others  have  published  very  interesting  cases, 
but  it  may  fairly  be  asked  whether  all  were  cases  of  true  tuberculosis 
due  to  the  microbe  which  Koch  discovered  in  man.  This  doubt,  how- 
ever, seems  to  have  been  removed  since  Koch,  Ribbert,  Babes,  Cornil, 
and  Megnin  found  in  tuberculous  material  obtained  from  fowls  a  bacillus 
showing  the  same  staining  properties  as  that  found  in  mammals. 

MM.  Nocard  and  Roux  cultivated  this  bacillus,  and  their  cultures, 
submitted  to  many  observers,  served  for  a  large  number  of  experi- 
ments. The  identity  of  the  two  forms  of  tuberculosis  was  freely 
admitted, — indeed,  could  scarcely  be  doubted  when  innumerable 
experiments  showed  that  the  rabbit  could  be  inoculated  with  avian 
tuberculosis,  and  when  several  observations  appeared  to  establish  the 
transmissibility  of  human  tuberculosis  to  birds. 

In  1873  Bollinger  reported  that  eight  pigeons  had  been  contami- 
nated by  eating  the  expectorations  of  phthisical  patients  ;  in  1885  he 
also  published  several  similar  cases.  Koch,  Nocard,  Mollereau, 
Chelchowsky,  de  Lemalleree,  Durieux,  and  Cagny  all  published  obser- 
vations,  or  experiments,  which  seemed   to   place  the  conveyance  of 


AVIAN    TUBERCULOSIS. — HISTORICAL,  523 

human  tuberculosis  to  fowls  beyond  question.  Nevertheless  some 
contradictory  facts  arose  from  time  to  time.  It  was  recalled  that 
Villemin  had  not  been  able  to  transmit  tuberculosis  to  a  cock  and  a 
wood-pigeon;  M.  H.  Martin  alwa5's  failed  in  attempting  to  inoculate 
fowls  by  intra-peritoneal  injection  with  tuberculous  material  derived 
directly  from  man,  or  with  material  which  had  been  passed  through 
the  guinea-pig.  But  the  idea  of  the  unicity  of  avian  and  human 
tuberculosis  had  already  struck  deep,  and  M.  Martin  carefully  guarded 
against  the  conclusion  that  fowls  are  proof  against  human  tuber- 
culosis ;  he  only  thought  his  failures  due  to  his  having  made  intra- 
peritoneal inoculations,  or  having  introduced  too  small  a  number  of 
bacilli. 

Rebutting  facts  soon  began  to  accumulate.  MM.  Straus  and 
Wurtz  fed  six  hens  and  a  cock  for  six  to  twelve  months  with  phthisical 
sputum.  The  animals  resisted,  and  post-uiortcin  examination  showed 
their  organs  to  be  perfectly  healthy. 

Riffi  and  Gotti  also  declared  that  the  tuberculosis  of  mammals  did 
not  affect  the  Gallinaceae.  Rivolta  laid  stress  on  the  considerable 
differences  between  avian  and  human  tuberculosis ;  he  found  that 
tuberculous  products  from  the  fowl  did  not  produce  general  infection 
in  the  guinea-pig,  the  lesions  being  confined  to  an  abscess  at  the  point 
of  inoculation.  The  same  results  occurred  in  the  rabbit,  though  in 
this  animal  a  few  tubercles  developed  in  the  lungs. 

The  study  of  tuberculosis  in  the  Gallinaceae  was  again  taken  up  by 
Maffucci.  This  author  recognised  that  avian  virus  was  transmissible 
to  fowls ;  that  in  the  rabbit  it  behaved  as  Rivolta  had  stated ;  and  that 
in  the  guinea-pig  its  action  varied  according  to  the  point  of  injection. 
The  animal  usually  resisted  inoculation  into  the  subcutaneous  con- 
nective tissue  though  it  showed  a  local  lesion  ;  in  other  cases  it  died  at 
the  end  of  some  months  in  an  extremely  emaciated  condition,  and  on 
post-mortem  examination  the  liver  and  spleen  were  found  atrophied  ;  no 
tubercles  were  seen,  and  microscopical  examination  and  cultures 
revealed  no  bacilli.  After  intra-peritoneal  inoculation  the  animals 
died  within  a  period  varying  between  fourteen  days  and  three  months  ;  if 
development  had  been  rapid  the  organs  were  infiltrated  with  embryonic 
cells  and  filled  with  bacilli  ;  in  more  prolonged  cases  atrophy  of  the 
liver  and  spleen  were  alone  found.  Inoculation  into  the  lung  pro- 
duced interstitial  inflammation;  the  bacilh  remained  localised,  and  did 
not  invade  abdominal  viscera  ;  after  intra-venous  inoculation  guinea- 
pigs  died  in  fifteen,  twenty,  or  twenty-five  days,  and  on  microscopic 
examination  the  liver  appeared  infiltrated  with  embryonic  cells  con- 
taining numerous  bacilli.     Finally  Maffucci  showed  that  mammalian 


524  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

tuberculosis  cannot  be  transmitted  to  the  Gallinaceae  :  twenty  fowls 
inoculated  under  the  skin,  in  the  stomach,  lung,  peritoneum,  and  veins 
all  resisted. 

The  interesting  researches  of  Rivolta  and  Maffucci  therefore  again 
rendered  it  doubtful  whether  tuberculosis  is  identical  in  various  species 
of  animals.  This  doubt  was  shared  by  Koch,  who  announced  at  the 
Berlin  Congress  that  he  had  resumed  the  study  of  the  question,  and 
that  in  his  view  the  tuberculosis  of  birds  was  not  in  all  respects  similar 
to  that  of  mammals.  At  this  time  we  published  a  preliminary  note  on 
the  same  subject.  Relying  on  a  considerable  number  of  experiments 
we  showed  that  avian  tuberculosis  can  be  transmitted  to  the  Galli- 
naceae ;  that  in  the  rabbit,  intra-peritoneal  inoculation  with  avian 
material  produces  generalised  miliary  tuberculosis ;  whilst  in  the 
guinea-pig  it  usually  produces  either  no  lesion  whatever,  or  only  a  few 
little  visceral  tubercles.  In  some  cases,  however,  avian,  like  human 
tuberculosis,  is  capable  of  producing  visceral  granulations  in  the 
guinea-pig.  Nevertheless,  speaking  generally,  the  avian  virus  behaves 
differently  in  the  rabbit  and  guinea-pig.  The  latter  animal,  though 
very  sensitive  to  mammalian  tuberculosis,  appears  very  resistent  to  the 
tuberculosis  of  Gallinaces. 

In  spite  of  the  differences  which  we  observed  between  the  two 
viruses  we  at  that  time  avoided  coming  to  any  fixed  conclusion  as  to 
their  nature. 

Regarding  the  importance  of  these  differential  characters,  we  said  : 
"  The  bacilli  of  human  and  avian  tuberculosis  are  regarded  as  two 
distinct  species,  or  two  varieties  of  one  species.  At  present  it  is  very 
difficult  to  settle  the  question  ;  study  of  other  microbes  has  shown  that 
their  form,  development  in  various  culture  media,  and  powers  of 
resistance  and  virulence  are  by  no  means  fixed  quantities,  and  vary 
under  different  circumstances.  This  question  may  possibly  be  cleared 
up  when  we  know  how  the  bacillus  of  human  tuberculosis  behaves  when 
inoculated  into  birds."  We  therefore  undertook  researches  in  this 
direction,  and  were  led  to  regard  the  two  bacilli  as  representing  two 
varieties  of  one  species. 

During  this  time  M.  Nocard  had  resumed  his  previous  experi- 
ments. He  again  attempted  to  transmit  mammalian  tuberculosis  to 
the  Gallinaceae.  This  time  his  results  were  negative,  and  he  concluded 
that  in  his  first  experiments  he  must  accidentally  have  utilised  a 
number  of  fowls  which  had  previously  suffered  from  avian  tuberculosis. 

Finally  MM.  Straus  and  Gamaleia,  in  an  important  memoir,  demon- 
strated in  striking  fashion  the  differences  between  the  viruses  of  the 
two  tuberculoses.     Among  the  new  facts  contributed  by  these  savants 


AVIAN    TUBERCULOSIS. ETIOLOGY.  525 

is  one  of  considerable  importance,  namely,  that  the  dog  reacts  in  an 
entirely  different  way  to  the  two  viruses.  It  readily  contracts  human, 
but  resists  avian  tuberculosis.  The  authors  were  thus  led  to  conclude 
that  the  two  bacilli  are  entirely  different,  and  represent  two  distinct 
species. 

On  our  side  we  continued  the  comparative  study  of  the  tubercu- 
losis of  birds  and  mammals.  Our  research,  though  prosecuted  for  the 
past  two  3'ears,  is  far  from  ended,  but  we  have  noted  certain  facts 
deserving  of  publication.  On  the  basis  of  our  own  researches,  and  of 
others  of  earlier  and  later  dates,  we  shall  endeavour  to  set  forth  the 
history  of  avian  tuberculosis. 

II.— ETIOLOGY. 

Tuberculosis  affects  the  fowl  as  well  as  man  with  remarkable 
frequency.  Of  600  fowls  examined  after  death  b}'  Ziirn,  62  were 
affected  with  tuberculosis.  If  this  result  truly  reflects  the  facts  tuber- 
culosis would  account  for  more  than  10  per  cent,  of  the  mortality  in 
these  birds. 

Pheasants,  guinea-fowls,  turkeys,  peacocks,  and  pigeons  are  also, 
though  less  frequently,  victims  of  tuberculosis.  In  order  to  discover 
the  means  by  which  the  disease  is  introduced  into  aviaries  and  poultry 
farms,  we  undertook  several  inquiries  and  addressed  a  list  of  questions 
to  nineteen  owners  or  breeders  who  had  sent  us  tuberculous  birds. 
Some  gave  no  reply;  others  useless  information.  We  were  only  able 
to  collect  eight  almost  complete  records  of  tuberculosis  among  fowls. 

In  three  of  these  epizootics  tuberculosis  had  clearly  been  introduced 
by  newly  purchased  birds.  The  first  outbreak  attacked  poultry  with- 
out affecting  pigeons  ;  the  second  was  confined  to  pheasants ;  the 
third  to  pheasants  and  poultry  without  affecting  the  peacocks. 

In  the  five  other  epizootics  the  origin  of  the  disease  remained 
obscure.  In  three,  fowls  alone  were  affected ;  in  one,  fowls  and 
turkeys ;  in  the  last,  pheasants.  Of  the  three  epizooties  in  which 
fowls  were  affected  one  occurred  in  a  new  fowl  run,  which  had  only 
been  inhabited  for  eight  months  ;  another  in  a  fowl  run  occupied  for  two 
years  ;  the  last  in  a  run  where  no  new  birds  had  been  introduced 
during  the  previous  five  years.  The  epizootics  which  attacked 
pheasants  had  not  been  preceded  by  any  importation  of  birds  for  a 
very  long  series  of  years. 

In  one  of  these  cases  we  were  able  to  discover  that  the  person  who 
looked  after  the  fowls  coughed  and  expectorated  a  greal  deal,  but 
examination  of  his  sputum  failed  to  reveal  the  presence  of  tubercle 


526  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

bacilli,  and  we  had  every  reason  to  believe  that  he  was  affected  with 
chronic  bronchitis.  In  another  we  learned  that  at  the  time  of  the 
outbreak  the  fowls  were  under  the  charge  of  a  young  woman  who  after 
showing  cough  and  expectoration  for  more  than  a  year,  had  become 
thin  and  was  regarded  as  suffering  from  tuberculosis. 

In  only  one  of  the  attacks  were  we  justified  in  supposing  that  the 
birds  had  been  inoculated  by  the  sputum  of  a  phthisical  patient,  as 
in  the  cases  related  by  Bollinger,  Nocard,  Mollereau,  Chelchowski, 
de  Lemalleree,  Durieux,  and  Cagny.  In  no  case  were  we  led  to 
suspect  the  ingestion  of  milk,  or  meat,  from  tuberculous  animals,  as 
in  MM.  Guerrin  and  Baivy's  cases. 

When  tuberculosis  is  imported  by  new  birds,  these  die  first,  and 
the  disease  afterwards  attacks  others.  The  mischief  is  rarely  con- 
fined to  a  few,  or  to  one  fowl,  as,  however,  happened  in  one  of  our 
cases  ;  usually  it  extends  successively  to  a  large  number  ;  sometimes 
it  continues  for  years  (four  years  in  one  of  our  cases),  and  ends  by 
completely  clearing  the  run. 

The  owners  of  these  badly  infected  fowl  runs  not  infrequently  sell 
the  surviving  birds,  which  being  thus  distributed  among  healthy 
subjects  communicate  the  disease  to  them. 

The  contaminated  fowl  runs  are  afterwards  cleansed,  disinfected, 
and  restocked,  but  even  when  they  have  remained  empty  for  several 
months  the  new  birds,  though  at  first  healthy,  soon  become  ill  and  die 
of  tuberculosis. 

Observation  of  these  epizootics  leaves  no  room  for  questioning  the 
contagious  character  of  tuberculosis  in  fowls.  Contagion  occurs 
through  the  medium  of  the  intestinal  dejections,  which  in  some  cases 
contain  very  large  numbers  of  bacilli.  Being  ingested  with  the  food 
the  bacilli  pass  through  the  intestine  and  gain  the  peritoneum,  liver, 
spleen,  and  in  rare  cases  other  organs.  In  about  half  the  cases  the 
passage  of  bacilli  through  the  intestinal  wall  leaves  no  trace. 
Under  such  circumstances  the  intestinal  contents  are  probably  free  of 
bacilli,  and  the  birds  are  incapable  of  transmitting  tuberculosis.  But 
in  other  instances  inoculation  is  marked  by  the  intestine  itself 
becoming  tuberculous  and  ulcerated.  The  dejections  are  then  rich  in 
bacilli,  the  distribution  of  which  over  the  ground  explains  the 
propagation  of  disease. 

III.— SYMPTOMS    AND    PATHOLOGICAL    ANATOMY. 

Symptoms. — The  signs  indicative  of  tuberculosis  in  fowls  are,  during 
life,  usually  very  vague.     The  birds  become  progressively  thinner,  and 


AVIAN    TUBERCULOSIS. — .ETIOLOGY.  527 

the  amount  of  wasting  may  be  estimated  by  palpation  of  the  thorax 
over  the  breast-bone  ;  the  pectoral  muscles  fall  away  and  the  bone 
projects  prominently.  At  the  same  time  other  phenomena  peculiar  to 
wasting  may  be  noted  :  the  comb  loses  its  red  colour,  and  the  mucous 
membranes  become  pale.  The  birds  die  in  this  condition  ;  towards  the 
end  paralytic  symptoms  have  several  times  been  observed. 

Under  these  conditions  diagnosis  is  difficult,  but  tuberculosis  may  be 
suspected  because  it  is  the  most  frequent  cause  of  wasting.  Under 
certain  cicumstances,  however,  the  observer  may  feel  more  certain 
of  the  nature  of  the  disease,  viz.  when  external  manifestations 
occur,  such  as  specific  changes  in  the  mucous  membranes  of  the 
head,  in  the  subcutaneous  connective  tissue,  and  in  the  bones  or 
joints  ;  in  the  latter  case  considerable  swellings  may  occur,  especially 
over  the  articulations  of  the  wings  and  feet. 

Pathological  Anatomy. — On  post-mortem  examination  the  intestine  is 
found  affected  in  about  half  the  number  of  cases.  The  peritoneum  is 
sometimes,  and  the  spleen  and  liver  are  almost  constantl}-,  the  seat  of 
new  growths. 

Tuberculosis  of  the  liver  is  indicated  by  the  existence  on  its  surface 
and  within  its  substance  of  tubercles  varying  in  size  between  that  of 
fine  dust  and  of  a  hazel-nut,  but  usually  of  about  a  pea.  The  super- 
ficial nodules  adhere  to  Glisson's  capsule,  beneath  which  they  some- 
times form  slight  projections.  Whether  superficial  or  deep-seated  they 
are  whitish  in  colour  when  small,  and  greyish  or  yellow  when  of  larger 
size.  Their  shape  is  spherical,  conical,  or  irregular  ;  and  they  may  be 
simple  or  confluent.  They  increase  both  the  size  and  weight  of  the 
liver  in  proportion  to  their  extent  and  number,  which  latter  is  usually 
considerable. 

The  hepatic  tissue  between  the  tuberculous  nodules  is  not  always 
unaffected  ;  on  the  post-mortem  examination  of  two  fowls  affected 
with  "  spontaneous  "  *  tuberculosis  we  found  in  the  right  hepatic  lobe 
large  haemorrhagic  infiltrations ;  in  one  the  blood  had  traversed 
Glisson's  capsule  and  passed  into  the  peritoneal  cavity. 

In  two  pheasants  affected  with  "spontaneous"  tuberculosis,  and  in 
four  fowls  which  had  been  inoculated  with  avian  tuberculosis,  we  found 
fibrinous  ascites  ;  in  three  cases  this  condition  existed  independently 
of  any  change  in  the  peritoneum,  and  appeared  therefore  to  have 
resulted  from  the  hepatic  lesions.  On  the  other  hand,  six  cases  showed 
peritoneal  tuberculosis  without  ascites. 

After  the  liver  the  spleen  is  the  organ  most  frequently  invaded. 

*  By  the  term  "spontaneous"  tuberculosis  is  here  meant  tuberculosis  not  produced  by 
experimental  inoculation. — Jn'O.  A.  W.  D. 


528 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


Sometimes  its  parenchyma  is  filled  with  small  granulations ;  sometimes 
it  contains  large  tuberculous  areas. 

In  all  our  observations  of  "  spontaneous  "  tuberculosis  the  kidneys 
and  lungs  remained  unaffected. 

In  about  half  the  cases  the  intestinal  mucous  membrane  showed 
either  small  tubercles,  or  ulcerations  of  greater  or  less  depth.  The 
latter  lesions,  which  indicate  the  point  of  entry  of  infection,  also  serve 
to  propagate  the  disease  ;  examination  of  the  intestinal  contents  several 
times  resulted  in  the  discovery  of  bacilli. 

We  should  also  mention  the  occurrence  of  tuberculous  lesions  in 


Fig.  76. — Tuberculosis  of  the  liver  (fowl). 


the  subcutaneous  connective  tissue,  in  bones,  articulations,  and  peri- 
articular tissues,  a  condition  which,  according  to  Friedberger  and 
Frohner,  is  fairly  frequent.  We  saw  a  remarkable  case  of  tuberculous 
arthritis  of  the  femoro-tibial  articulation.  The  lesion  occurred  in  a 
fowl  dead  of  spontaneous  tuberculosis,  and  was  extremely  rich  in  bacilli. 
Tuberculosis  of  the  pheasant  and  of  the  fowl  are  practically  indis- 
tinguishable to  the  naked  eye,  but  on  applying  iodine  solution  the 
tubercles  in  the  pheasant  assume  the  mahogany  coloration  charac- 
teristic of  amyloid  degeneration. 

Histology. — Histologically  the  lesions  in  the  fowl  and  in  the  phea- 
sant vary  to  a  marked  extent.     This  was  shown  by  microscopic  exa- 


AVIAN    TUBERCULOSIS.  — SYMPTOMS    AND    PATHOLOGICAL    ANATOMV.  529 

minations  carried  out  principally  on  the  liver,  an  organ  which  readily 
lends  itself  to  a  study  of  this  character. 

In  the  pheasant  the  smallest  tubercles  are  formed  by  a  central  mass 
of  epithelioid  cells  surrounded  by  round  cells. 

In  the  largest  tubercles  the  centre  displays  a  cavity  containing 
epithelioid  cells,  either  crowded  together  in  large  numbers,  or  few  and 
separate.  This  cavity,  being  more  or  less  rounded  and  usually  sharply 
delimited  by  a  layer  of  dense  connective  tissue,  might  be  mistaken  for 
a  vessel  unless  care  were  taken  to  examine  a  series  of  preparations.  It 
is  surrounded  by  layers  of  epithelioid  cells.  The  latter  are  separated 
from  one  another  by  connective  tissue  attached  to  that  surrounding 
the  central  cavity.  Finally,  the  periphery  of  the  tubercles  is  often 
surrounded  by  a  layer  of  round  cells. 

The  largest  tubercles  show  two  well-defined  zones,  a  central  and 
a  peripheral.  The  internal  is  chiefly  formed  by  a  compact  or  vacuo- 
lated connective  tissue,  the  cells  of  which,  however,  display  no  nuclei 
capable  of  being  stained.  Here,  again,  we  find  the  pseudo-vascular 
cavity,  which  only  contains  shapeless  cellular  debris  and  granulations. 
The  peripheral  zone  is  composed  of  masses  of  epithelioid  cells  separated 
by  connective  tissue,  and  is  surrounded  by  round  cells. 

Such  is  the  structure  of  the  simple  tubercles.  At  many  points 
these  approach,  touch,  or  become  mutually  fused  together,  so  much 
so  that  in  the  internal  zone  of  the  largest  tubercles,  for  example,  one 
generally  finds  several  cavities  resembling  blood-vessels. 

The  epithelioid  cells  which  enter  into  the  formation  of  the  tubercles 
are  generally  provided  with  a  single  nucleus ;  a  certain  number,  how- 
ever, possess  several,  and  some,  of  enormous  size  and  principally 
situated  in  the  centre  of  the  tubercles,  are  half  surrounded,  or  even 
completely  surrounded,  bj^  nuclei,  forming  true  giant-cells. 

The  connective  tissue  of  the  tubercles  is  coloured  brownish  red  by 
a  watery  solution  of  iodine,  and  rose-red  by  methyl  violet,  thus  resem- 
bling amyloid  material. 

The  bacilli  in  the  tubercles  stain  readily  by  Ehrlich's  or  Herman's 
methods.  They  are  either  isolated,  or,  as  has  been  well  figured  by 
MM.  Cornil  and  Megnin,  collected  in  more  or  less  rounded  clumps, 
surrounded  by  epithelioid  cells.  Though  numerous  in  the  epithelioid 
"  nests,"  of  which  the  smallest  tubercles  consist,  they  are  even  more 
common  in  tubercles  of  medium  size,  particularly  in  their  pseudo- 
vascular  spaces,  where  they  often  form  compact  masses.  They  par- 
tially or  entirely  disappear  in  the  internal  zone  of  the  largest  tubercles. 

The  hepatic  tissue  between  the  tubercles  shows  no  alteration,  and 

L  L 


530  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY 

in  particular  presents  neither  fatty  nor  amyloid  degeneration,  nodular 
hepatitis,  nor  cirrhosis. 

The  preceding  histological  details  would  appear  to  suggest  that  in 
the  pheasant  the  development  and  subsequent  course  of  hepatic  tuber- 
culosis is  somewhat  as  follows.  A  colony  of  tuberculous  bacilli  first 
becomes  arrested  at  some  point  in  the  liver,  where  the  bacilli  multiply 
and  cause  a  local  reaction,  indicated  by  the  production  of  a  nest  of 
epithelioid  cells.  Around  this  nest  round  cells  group  themselves,  and 
a  limiting  connective-tissue  membrane  forms,  which  on  section  re- 
sembles the  wall  of  a  blood-vessel.  This  barrier  is  insufficient  to 
prevent  the  spread  of  the  tuberculous  process.  The  bacilli  pass  it, 
extend  beyond,  multiply,  and  cause  the  development  of  fresh  nests  of 
epithelioid  cells,  which  become  surrounded  by  fresh  fibrous  limiting 
membranes.  The  bacilli  thus  gradually  progress,  exciting  an  epi- 
thelioid reaction  and  further  formation  of  fibrous  tissue,  which,  as  we 
have  seen,  undergoes  amyloid  degeneration.  When  the  tubercles 
attain  a  certain  size  the  connective  tissue  in  the  central  parts  becomes 
thickened,  the  epithelioid  cells  undergo  degeneration,  and  the  bacilli 
cease  to  stain,  but  their  periphery  presents  an  active  zone  extremely 
rich  in  bacilli  and  epithelioid  cells,  the  further  growth  of  which  only 
ceases  with  the  death  of  the  animal. 

In  the  fowl  the  smallest  tubercles  are  formed  of  a  mass  of  epi- 
thelioid cells,  surrounded  by  others  of  a  spherical  and  fusiform  outline. 
The  larger  show  a  central  necrotic,  hyaline  portion  coloured  brown  by 
picro-carmine.  Around  this  hyaline  centre  is  arranged  a  border  of  epi- 
thelioid cells,  usually  of  considerable  size,  and  always  containing  a 
large  number  of  nuclei,  which  stain  vividly  with  carmine.  These  cells 
are  generally  elongated,  and  more  or  less  cylindrical  in  shape,  and  are 
arranged  perpendicularly  to  the  hyaline  zone  ;  they  contain  nuclei 
principally  collected  at  that  extremity  of  the  cell  farthest  from  the 
hyaline  zone.  It  might  thus  seem  at  first  sight  as  though  the  hyaline 
mass  were  contained  within  a  bile-duct,  in  the  same  way  that  a  super- 
ficial examination  might  suggest  the  existence  of  vascular  cavities  at 
the  centre  of  the  tubercles  in  the  pheasant.  Outside  the  border  formed 
around  the  hyaline  zone  by  the  above-mentioned  epithelioid  cells  are 
masses  of  ordinary  epithelioid  cells.  The  extreme  periphery  of  the 
tubercle  is  indicated  by  round  and  fusiform  cells. 

Certain  tubercles  of  similar  size  to  the  preceding  are  simply  formed 
by  masses  of  epithelioid  cells,  without  the  hyaline  zone  and  border  of 
epithelioid  cells  which  distinguish  the  former.  In  other  tubercles,  on 
the  contrary,  the  central  epithelioid  mass  shows  a  hyaline  zone  and  a 


AVIAN    TUBERCULOSIS. — SYMPTOMS    AND    PATHOLOGICAL    ANATOMY.  531 

border  of  epithelioid  cells,  distinguished  from  the  others  by  their 
direction,  form,  large  size,  number,  and  by  the  position  and  staining 
of  their  nuclei.  In  some  of  these  tubercles  the  hyaline  zones  tend  to 
become,  or  do  in  reality  become,  fused. 

The  largest  tubercles,  composed  of  large  numbers  of  epithelioid 
masses,  display  a  faint  indication  of  a  connective-tissue  capsule.  The 
hyaline  degeneration  is  then  extensive,  and  replaces  the  epithelioid  cells. 
Certain  of  these  tubercles  resemble  old  syphilitic  gummata,  and  appear 
simply  formed  of  an  encapsuled  hyaline  mass. 

In  tuberculosis  of  the  fowl  the  bacilli  stain  readily  by  Ehrlich's 
method.  They  are  contained  in  very  large  numbers  in  the  epithelioid 
cells,  and  though  usually  isolated  are  sometimes  collected  in  clumps, 
as  in  tuberculosis  of  the  pheasant.  They  are  also  found  in  the  smallest 
tubercles  formed  of  a  simple  mass  of  epithelioid  cells.  In  the  larger 
tubercles  they  are  more  numerous,  particularly  in  the  vitreous  zone, 
where  they  appear  of  great  size  and  with  a  tendency  to  branch  :  the 
epithelioid  border  of  the  hyaline  zone,  on  the  contrary,  contains  ex- 
tremely few ;  under  any  circumstances  it  contains  much  fewer  than  the 
epithelioid  masses  towards  the  periphery  of  these  tubercles. 

The  first  stage  in  the  tuberculous  process  in  the  liver  of  the  fowl, 
as  in  that  of  the  pheasant,  is  therefore  marked  by  the  development,  in 
consequence  of  microbic  irritation,  of  an  epithelioid  mass,  which  is 
surrounded  by  spherical  and  fusiform  cells.  Around  this  primary 
mass  of  epithelioid  cells  others  successively  form.  The  centre  of  the 
primary  clump  of  cells  undergoes  hyaline  degeneration,  as  does  that  of 
the  later  formations ;  necrobiosis  tends  to  replace  the  tuberculous 
neoplasis,  whilst  a  fibrous  barrier  develops  around  the  periphery  of  the 
tubercle.  The  tubercle  may  thus  cease  to  grow,  and  become  com- 
pletely transformed  into  an  encysted  hyaline  mass.  But  this  is  excep- 
tional ;  whilst  the  older  portions  of  the  tubercles  undergo  degeneration 
bacilli  escape  through  the  imperfect  fibrous  barrier  which  surrounds 
them  and  spread  into  healthy  tissue,  in  which  they  produce  a  crop  of 
fresh  tubercles. 

To  sum  up,  although  the  initial  stages  of  tubercle  formation  in  the 
liver  of  the  fowl  and  of  the  pheasant  are  identical,  later  development  is 
marked  by  notable  differences. 

In  the  pheasant  the  tubercle  bacillus  causes  development  of  epi- 
thelioid cells ;  these  soon  undergo  molecular  degeneration  and  are 
succeeded  by  formation  of  abundant  connective  tissue,  which  surrounds 
pseudo-vascular  cavities  and  undergoes  amyloid  degeneration. 

In  the  fowl  the  epithelioid  cells  undergo  hyaline  necrobiosis,  which, 


532  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

though  at  first  limited  to  the  centre  of  the  tubercle,  and  producing  the 
appearance  of  a  clear  centre  surrounded  by  special  epithelioid  cells, 
afterwards  extends  to  the  whole  of  the  new  growth  and  tends  to  en- 
cystment. 

The  histological  appearances  of  tuberculosis  of  the  liver  in  the 
fowl  and  in  the  pheasant  so  greatly  differ  that  at  first  sight  the  micro- 
organisms producing  the  lesions  might  be  regarded  as  of  different 
species.     This  interpretation,  however,  would  be  erroneous. 

We  have  inoculated  from  the  pheasant  to  the  fowl,  and  in  the 
liver  of  the  latter  have  found  histological  lesions  identical  with  those 
of  spontaneous  fowl  tuberculosis. 

Although  the  production  of  tubercles,  both  in  the  fowl  and  in  the 
pheasant,  is  due  to  the  same  bacillus,  the  development  of  these  growths 
is  none  the  less  affected  by  peculiarities  of  the  host.  It  is  the  story 
once  more  of  the  grain  and  the  soil.  Not  only  do  the  hepatic  tubercles 
in  the  fowl  and  pheasant  differ  from  hepatic  tubercles  in  mammals,  but 
they  vary  to  a  marked  extent  between  themselves,  although  developed 
in  such  nearly  related  species.  We  cannot  lay  too  much  stress  on  this 
fact,  which  throws  so  prominently  into  relief  the  pathological  peculiari- 
ties of  animals,  and  which  shows  how  dangerous  it  is  to  indulge  in 
general  conclusions  drawn  from  experiments  on  a  single  species. 

IV.— EXPERIMENTAL    STUDY. 

Only  one  method  existed  of  determining  the  nature  of  avian 
tuberculosis,  viz.  the  experimental.  Only  after  having  shown  how  the 
virus  of  avian  tuberculosis  behaves  in  mammals,  and  how  that  of 
mammals  behaves  in  birds,  could  we  even  attack  the  continually  recur- 
ring problem  of  the  unicity  of  tuberculosis  in  various  species  of  animals. 
We  may  therefore  divide  this  chapter  into  two  parts,  and  we  shall 
commence  b}'  giving  the  particulars  of  experiments  made  with  avian 
tuberculosis. 

Part  I. — Inocidation  Experiments  with  Tuberculosis  of  the  GallinacecB. 

To  study  the  effects  of  the  avian  virus  we  directly  inoculated  from 
lesions  developed  in  the  Gallinacese  and  utilised  in  our  experiments  a 
considerable  number  of  birds  drawn  from  different  localities,  a  fact  which 
may  be  regarded  as  giving  a  certain  general  character  to  our  results, 
and  also  explaining  some  apparently  contradictory  results  which  we 
have  observed. 

We  obtained  our  virulent  material  from  eleven  subjects — eight 
fowls,  two  pheasants,  and  one  guinea-fowl — sent  us  b)'  different  owners 
and  breeders.     In  all  these  animals  post-nwrtcin  examination   showed 


AVIAN    TUBERCULOSIS. — SYMPTOMS    AND    PATHOLOGICAL    ANATOMY.  533 

the  existence  of  tuberculous  lesions,  and  bacteriological  examination 
revealed  the  presence  of  the  characteristic  bacilli.  For  our  inoculations 
we  utilised  growths  from  the  liver.  Fragments  of  the  viscus  were 
crushed  in  sterilised  water,  and  the  emulsion  thus  obtained  was  in- 
jected into  a  certain  number  of  animals.  Unless  otherwise  indicated, 
all  inoculations  will  be  understood  to  have  been  made  into  the  peri- 
toneal cavity. 

Inoculation  of  Fowls. — That  the  Gallinacese  may  be  inoculated  with 
avian  tuberculosis  has  been  placed  beyond  doubt  by  the  study  of  epizo- 
otics in  fowl  runs,  and  by  a  certain  number  of  experimental  researches. 
We  did  not  therefore  undertake  numerous  experiments  on  this  point. 

Six  fowls  were  inoculated  with  spontaneous  avian  tuberculosis.  Two 
received  the  virus  in  the  axillary  vein  ;  they  fell  away  in  condition,  and 
died  at  the  end  of  thirty-nine  and  fifty-three  days  respectively.  The 
liver  and  spleen  were  crammed  with  tubercles  ;  in  one  abundant  fibrin- 
ous ascites  and  peritoneal  granulations  were  discovered.  The  four  others 
were  inoculated  in  the  abdominal  cavity  ;  they  died  at  the  end  of  from 
forty-one  to  ninety-three  days.  Post-mortem  examination  revealed  the 
presence  of  numerous  granulations  in  the  liver,  spleen,  and  on  the 
peritoneum  ;  in  two  cases  the  abdominal  cavity  contained  a  rather 
abundant  fibrinous  liquid.  In  all  these  animals  histological  examina- 
tion of  the  liver  showed  the  presence  of  bacilli  and  of  lesions  similar 
to  those  found  in  cases  of  spontaneous*  tuberculosis. 

On  another  occasion  we  attempted  to  transmit  in  series  these 
tuberculous  products  ;  the  result  was  negative :  the  second  fowl,  killed 
at  the  end  of  165  days,  showed  no  lesion.  This  result  should,  how- 
ever, be  regarded  as  absolutely  accidental,  and  was  probably  due  to  a 
peculiar  resistance  on  the  part  of  the  animal  inoculated.  The  history 
of  other  infectious  diseases  reveals  analogous  occurrences.  In  another 
case  we  performed  series  of  inoculations,  and  were  able  to  transmit 
tuberculosis  in  succession  to  four  fowls. 

Inoculation  of  Rabbits. — Numerous  experiments  carried  out  in  France 
with  avian  cultures  showed  that  the  rabbit  is  very  sensitive  to  this  form 
of  tuberculosis.  Intra-peritoneal  inoculation  produces  visceral  granu- 
lations, and  intra-venous  inoculation  has  the  same  effect,  provided  too 
large  a  quantity  of  virus  be  not  injected,  otherwise  the  animal  dies  with 
lesions  of  the  Yersin  type. 

The  results  of  avian  inoculation  in  the  rabbit  being  already  fairly 
well  known,  we  only  made  a  few  experiments.  Five  rabbits  were  inocu- 

*  As  already  mentioned,  by  spontaneous  tuberculosis  is  here  meant  disease  not  produced 
by  experimental  inoculation.— Jno.  A.  W.  D. 


534  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

lated  in  the  abdominal  cavity  with  a  few  drops  of  an  emulsion  prepared 
from  the  liver  of  tuberculous  fowls  :  three  of  them  died  between  sixty- 
nine  and  eighty-seven  days  after  inoculation  ;  another  was  killed  at  the 
end  of  io8  days.  In  these  four  Simma.ls  post-inortein  examination  showed 
generalised  tuberculosis ;  the  peritoneum,  and  especially  the  epiploon, 
were  dotted  over  with  little  tuberculous  granulations ;  the  liver  and 
spleen  were  crammed  with  them  ;  the  lungs  and  kidneys,  however,  con- 
tained a  smaller  number.  Several  times  we  microscopically  examined 
the  invaded  organs,  which  we  found  contained  large  numbers  of  bacilli ; 
the  structure  of  the  tubercles  showed  nothing  special. 

We  must  now  mention  an  experiment  in  which  the  development  of 
avian  tuberculosis  showed  peculiar  features. 

On  the  i6th  June,  1890,  two  rabbits  were  inoculated  from  the  liver 
of  a  fowl.  One  died  in  sixty-nine  days  from  generalised  tuberculosis. 
The  other  remained  in  good  health  until  the  3rd  January,  iSgi,  at 
which  time  swelling  of  the  right  hock  was  noted  ;  some  days  later  the 
radio-carpal  joint  of  the  same  side  was  in  turn  attacked.  On  palpation 
numbers  of  fungous  growths  could  be  detected  developed  around  the 
joints  first  invaded  ;  these  soon  projected  beneath  the  skin  ;  at  the 
antero-external  part  of  the  carpal  region  they  perforated  the  skin,  and 
appeared  externally  as  reddish,  soft  granulations.  In  order  to  make 
certain  as  to  the  nature  of  the  articular  lesions,  we  had,  before  the 
external  appearance  of  the  granulations,  punctured  the  parts  aseptically 
with  a  Pravaz's  syringe,  and  thus  obtained  a  few  drops  of  liquid  con- 
taining the  characteristic  bacilli. 

In  spite  of  the  existence  of  these  fungating  growths  the  animal's 
general  health  remained  excellent,  and  its  condition  even  improved. 
On  the  5th  January  the  subject  weighed  5  lbs.  g^  oz.  At  that  time 
we  subcutaneously  injected  "25  c.c.  (that  is  at  the  rate  of  o'l  c.c.  per 
kilo,  of  body-weight)  of  tuberculin.  We  had  previously  satisfied  our- 
selves that  a  similar  or  even  larger  dose  produced  no  disturbance  in  a 
normal  rabbit.  The  injection  was  made  at  11  a.m.,  and  the  animal 
seemed  to  experience  no  effect  throughout  the  day.  At  7  a.m.  next 
morning,  however,  it  was  dead. 

On  post-mortem  examination  the  lungs  were  found  engorged  with 
blood ;  they  contained  a  few  disseminated  tuberculous  granules.  The 
liver  was  congested,  and  contained  five  or  six  tubercles  ;  two  were  also 
found  in  the  spleen,  which  was  of  very  large  size.  The  kidneys  were 
enormous  and  violet  in  colour  :  they  only  contained  two  or  three  little 
granules.  Examination  of  the  affected  joints  showed  that  the  fun- 
gating  growths  had  invaded  the  synovial  membranes  and  periarticular 
tissues. 


AVIAN    TUBERCULOSIS. — EXPERIMENTAL    STUDY.  535 

This  case,  which  we  reported  to  the  Societe  de  Biologic,  appeared 
to  us  interesting  for  several  reasons.  It  furnished  a  new  example  of 
varying  resistance  in  two  animals  of  the  same  species  inoculated  in  the 
same  way.  It  furnished  a  good  type  of  experimental  tuberculous  joint- 
disease.  Finally,  it  showed  that  animals  affected  with  avian  tuberculosis 
reacted  to  tuberculin  like  animals  affected  with  human  tuberculosis  ;  in 
both  cases  large  doses  of  tuberculin  produce  death  with  intense  con- 
gestive symptoms  precisely  similar  to  those  just  described. 

To  sum  up,  avian  tubercular  material,  when  inoculated  into  the  peri- 
toneum of  the  rabbit,  generally  produces  tuberculous  granulations  ;  in 
most  cases  all  the  viscera  are  affected,  and  death  occurs  on  an  average 
at  the  end  of  eighty  days.  In  some  cases,  however,  the  animals  remain 
to  all  appearance  in  good  health,  and  when  killed  astonish  the  experi- 
menter by  displaying  generalised  tuberculosis. 

It  will  be  seen  how  greatly  our  results  differ  from  those  of  Rivolta 
and  Maffucci.  These  two  Italian  investigators  regard  avian  tuberculosis 
as  scarcely  pathogenic  for  the  rabbit,  and  as  only  producing  a  few  very 
discrete  pulmonary  granulations.  From  our  experiments  it  will  be  seen 
that  the  virus,  when  introduced  into  the  peritoneum,  produces  general- 
ised tuberculosis,  and,  in  fact,  acts  on  the  rabbit  as  does  mammalian 
tuberculosis. 

Inoculation  of  Guinea-pigs. — The  experiments  of  Rivolta  and  Maffucci 
have  shown,  as  we  said,  the  great  difficulty  of  transmitting  avian  tuber- 
culosis to  guinea-pigs.  MM.  Cornil  and  Megnin,  who  inoculated  two 
guinea-pigs,  failed  to  discover  any  visceral  changes  when  the  animals 
were  killed  two  months  later  ;  the  subjects  only  showed  an  abscess 
containing  bacilli  in  the  abdominal  wall.  They  thought  that  generalisa- 
tion would  have  occurred  had  they  waited  longer  before  terminating 
the  experiment. 

MM.  Straus  and  Gamaleia,  after  intra-peritoneally  inoculating 
guinea-pigs  with  avian  tuberculosis,  found  that  death  occurred  in  two 
to  four  weeks.  On  post-mortem  examination  no  lesion  was  found,  or 
the  spleen  simply  appeared  rather  large  and  red ;  in  whatever  way  the 
material  was  introduced,  tubercles  failed  to  develop.  These  observers 
several  times  detected  bacilli  in  the  viscera,  but  the  organisms  had 
never  produced  any  formation  of  nodules. 

Our  experiments  extended  to  twenty-four  guinea-pigs,  which  were 
intra-peritoneally  injected  with  emulsions  prepared  with  material  from 
the  livers  of  tuberculous  birds.  In  several  cases  we  simultaneously 
injected  a  few  drops  under  the  skin. 


536  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

In  the  latter  cases  the  results  were  as  follows  : — At  the  point  of 
inoculation  a  small  caseous  abscess  containing  numerous  bacilli  formed, 
but  healed  in  a  few  weeks.  Whether  or  not  this  local  lesion  developed, 
the  lymphatic  glands  in  the  neighbourhood  of  the  inoculated  spot  (in 
this  case  the  inguinal  glands)  generally  became  enlarged  ;  instead  of 
extending  and  becoming  generalised,  however,  this  glandular  inflamma- 
tion, which  was  especially  marked  from  the  eighth  to  the  ninth  or 
twentieth  day,  retroceded,  and  ended  by  disappearing.  Most  frequently 
the  animals  remained  in  good  health,  and  did  not  fall  away  in  condition. 
They  showed  nothing  indicating  disease  ;  a  local  infection,  characterised 
by  the  inoculation  abscess  and  by  inflammation  of  lymph-glands,  cer- 
tainly occurred  at  the  time,  but  these  lesions  were  temporary,  and 
rapidly  disappeared. 

Of  twenty-four  guinea-pigs  inoculated  six  died  spontaneously, 
one  rapidly  in  r6  days,  as  in  Straus  and  Gamaleia's  experiments ;  the 
others  lived  for  a  period  varying  between  30  and  164  days.  The 
post-mortem  examination  of  these  animals  was  negative,  in  the  sense 
that  examination  of  the  viscera  showed  no  lesion  resembling  tuber- 
culosis. We  simply  add  that  one  guinea-pig  showed  at  the  point  of 
inoculation  in  the  peritoneum  a  small,  entirely  encysted  caseous  abscess. 
The  other  animals  remained  in  perfect  health,  and  were  killed 
between  the  iiith  and  248th  day  after  inoculation;  in  nine  the  results 
were  negative ;  there  was  no  appreciable  lesion  except  in  one  guinea- 
pig,  which  showed  a  little  encysted  abscess  in  the  peritoneum. 

In  short,  of  the  fifteen  guinea-pigs  inoculated  with  avian  tuber- 
culosis which  died  spontaneously,  or  were  killed,  the  organs  remained 
absolutely  unaffected ;  no  appreciable  lesion  was  found  except  in  two 
animals,  each  of  which  exhibited  a  caseous  abscess  similar  to  those 
already  discovered  by  Cornil  and  Megnin. 

Six  other  guinea-pigs  were  killed  like  the  preceding  whilst  still  in 
very  good  bodily  condition,  but  the  autopsy  showed  the  presence  of 
tuberculous  granulations.  The  number  and  the  localisation  of  these, 
however,  differed  entirely  from  what  has  been  noted  after  inoculation 
with  human  tuberculosis ;  instead  of  becoming  generalised  the  lesions 
were  confined  to  one  or  two  viscera,  or  to  the  peritoneum ;  in  one  case 
the  serous  membrane  was  alone  affected,  five  or  six  miliary  granula- 
tions being  found  in  the  perihepatic  portion.  In  addition,  infection 
had  extended  to  the  liver  and  spleen,  but  careful  examination  was 
required  to  detect  it.  Each  of  these  viscera  contained  three  or  four 
small  granulations,  so  that  the  appearance  of  the  organs  was  hardly 
modified.  In  particular  the  spleen  showed  none  of  the  hypertrophy 
generally  seen  in  experimental  tuberculosis  in  rodents. 


AVIAN    TUBERCULOSIS. — EXPERIMENTAL    STUDY.  537 

In  two  cases  the  lesions  were  again  very  different  from  those  usually 
observed  ;  the  abdominal  organs  were  normal,  the  lungs  alone  con- 
taining two  or  three  pearly  tubercles,  the  size  of  millet-seeds,  projecting 
beneath  the  pleura. 

Microscopic  examination  of  these  lesions  revealed  bacilli  remarkable 
for  their  size,  which  was  somewhat  greater  than  that  of  the  human 
bacillus,  and  for  their  more  granular  appearance. 

The  pulmonary  new  growths  were  formed  of  a  mass  of  epithelioid 
cells  ;  giant-cells  were  absent,  and  the  periphery  of  the  lesions  exhibited 
very  few  embryonic  cells. 

The  hepatic  tubercles  had  a  special  appearance.  In  one  case  the 
granules  were  formed  of  a  caseous  centre  surrounded  by  a  fibrous  zone  ; 
in  another,  a  tubercle  had  been  entirely  transformed  into  a  fibrous 
mass  ;  this  was  unquestionably  a  tubercle  in  course  of  healing. 

Histological  study,  therefore,  showed  that  the  lesions  produced  in 
guinea-pigs  by  inoculation  with  avian  tuberculosis  tend  to  become 
localised  and  to  heal.  This  tendency  towards  spontaneous  recovery 
had  already  been  suggested  by  the  course  taken  by  the  local  tubercle 
resulting  from  inoculation  and  by  the  glandular  inflammation. 

To  sum  up,  avian  tuberculosis  behaves  quite  differently  in  the  rabbit 
and  in  the  guinea-pig.  This  fact,  which  escaped  Rivolta  and  Maffucci, 
and  which  we  were  the  first  to  note,  has  been  confirmed  by  the 
researches  of  different  authors,  and  by  the  results  of  further  experi- 
ments which  we  have  carried  out.  Thus  we  are  led  to  conclude  that 
avian,  unlike  human  tuberculosis,  is  more  active  in  the  rabbit  than  in 
the  guinea-pig.  In  the  latter  animal  it  either  causes  no  lesions,  or 
gives  rise  to  a  caseous  abscess,  or  finally  produces  a  few  rare  visceral 
tubercles,  which  scarcely  interfere  with  the  animal's  general  health,  and 
tend  to  undergo  fibrous  transformation,  that  is,  to  heal. 

But  although  the  results  just  noted  are  generally  constant,  they 
are  subject  to  certain  exceptions. 

A  guinea-pig  which  had  been  inoculated  with  a  fragment  of  liver 
from  a  fowl,  which  again  had  been  inoculated  from  the  liver  of  a 
pheasant,  died  at  the  end  of  103  days.  At  the  autopsy  it  was  found 
suffering  from  generalised  miliary  tuberculosis ;  the  peritoneum  con- 
tained a  certain  quantity  of  serous  liquid ;  the  liver,  which  weighed 
if  ounces,  and  the  spleen,  which  weighed  2j  drachms,  were  crammed 
with  tubercles ;  the  lungs  also  showed  granulations.  The  lesions 
were,  in  fact,  similar  to  those  seen  after  inoculation  with  human  tuber- 
culosis. 

From  this  guinea-pig  a  second  was  inoculated.    The  latter  remained 


538  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

in  perfect  health  ;  when  killed  at  the  end  of  141  days  its  condition 
appeared  perfectly  normal ;  post-mortem  examination  revealed  the 
existence  of  five  or  six  scattered  tubercles  in  the  liver  and  lungs ;  the 
spleen  was  healthy.  The  virus,  instead  of  increasing  in  virulence, 
seemed  therefore  to  have  become  attenuated  by  passage  through  two 
guinea-pigs. 

To  continue  the  series  we  inoculated  another  guinea-pig  and  a 
rabbit  from  the  liver  of  this  animal.  The  guinea-pig  died  on  the  logth 
day,  a  dozen  granulations  being  found  in  its  liver.  The  rabbit  remained 
in  good  health  and  was  killed  at  the  end  of  139  days.  The  cadaver 
showed  numerous  granulations  remarkable  for  their  localisation  ; 
instead  of  having  invaded  the  liver  and  spleen  they  occupied  the  lungs, 
mediastinal  lymphatic  glands,  and  kidneys.  To  test  the  results  of 
inoculation  with  this  virus,  which  had  behaved  in  such  a  peculiar 
manner,  we  utilised  it  to  inject  a  guinea-pig  and  two  fowls.  The 
guinea-pig  remained  in  apparently  good  health,  but  on  killing  it  at  the 
end  of  169  days  we  were  not  a  little  surprised  to  find  it  suffering  from 
generalised  tuberculosis ;  the  lungs,  peritoneum,  spleen,  and  liver  were 
filled  with  granulations  ;  the  liver  was  the  seat  of  very  marked  cirrhosis, 
which  rendered  its  surface  bosselated  and  deeply  channelled.  The 
fowls  were  killed  at  the  end  of  169  and  176  days  respectively,  but  the 
autopsy  revealed  no  appreciable  lesion. 

Thus  after  passing  three  times  through  mammals  the  avian  virus 
behaved  very  much  like  that  of  human  tuberculosis  ;  it  produced 
tubercle  in  the  guinea-pig  but  failed  to  affect  the  fowl.  It  might, 
therefore,  be  suggested  that  in  this  second  series  accidental  inoculation 
with  mammalian  tuberculosis  had  occurred,  but  such  a  supposition 
appears  to  us  inadmissible.  Along  with  the  first  guinea-pig,  which 
showed  generalised  tuberculosis,  a  second  had  been  inoculated  ;  the 
same  syringe  had  been  employed,  and  the  two  guinea-pigs  had  been 
placed  in  the  same  cage  ;  now  one  of  these  behaved  as  usual,  the 
other  died  from  generalised  tuberculosis.  Accidental  contamination, 
moreover,  seems  to  us  less  probable,  as  at  this  time  the  laboratory  con- 
tained animals  inoculated  only  with  avian  tuberculosis. 

The  above  experiments  show  that  in  some  cases  intra-peritoneal 
inoculation  with  avian  tuberculosis  may  produce  in  the  guinea-pig  a 
generalised  crop  of  tubercles  ;  such  a  result  is  somewhat  rare,  but  is 
indisputable,  and  has,  moreover,  been  confirmed  by  MM.  Courmont 
and  Dor,  who  have  also  obtained  generalised  tuberculosis  by  ino- 
culating with  avian  cultures.  To  enable  the  reader  to  more  readily 
follow  our  experiments,  we  give  the   results  below    in   tabular  form. 


AVIAN    TUBERCULOSIS. EXPERIMENTAL    STUDY. 


539 


The  tables  describe  the  animals  which  provided  the  material  for  ex^ 
periment ;  those  in  which  inoculations  w^ere  practised,  the  after  history, 
and  the  principal  results  of  the  autopsy.  The  asterisks  indicate 
animals  which  were  intra-venously  injected.  All  others  were  inoculated 
intra-peritoneally. 


FOWL  L 

Tuberculosis  of  the  liver  and  spleen. 
November  7th,  1889. 

i 

Fowl.* 

Died  December  30th  (53  days  afterwards). 

Tuberculosis  of  the  liver  and  spleen. 


i 

Guinea-pig. 
Killed  June  8th  (158  days  afterwards). 
Two  or  three  granulations  in  the  lungs. 


Fowl. 
Killed  June  15th  (165  days  afterwards). 

No  lesion. 


FOWL  II. 

Tubercidosis  of  the  intestine,  liver,  and  spleen. 
December  30th,  1889. 


Guinea-pig. 

Killed  June  15th  (165  days 

afterwards). 

No  lesion. 


Rabbit. 
Died  April  6th,  1890  (97 

days  afterwards). 

Generalised  tuberculosis  of 

peritoneum,   spleen,    liver, 

kidneys,  and  luns^s. 

I 

Rabbit. 

Killed  June  15th  (70  days 

afterwards). 

No  lesion. 


Fowl. 
Died  February  loth,  1890  (41 

days  afterwards). 
Ascites,    tuberculosis   of    the 
peritoneum,  liver,  and  spleen. 


Guinea-pig. 

Died  February  26th  (16  days 

afterwards). 

N'o  lesion. 


FOWL  III. 

Tuberculosis  of  the  liver  and  spleen. 

January  25th,  1890. 

I 

Guinea-pig. 

Killed  June  15th  (140  days  afterwards). 

No  lesion. 


FOWL  IV. 

Tuberculosis  of  the  intestine,  liver,  spleen,  and  peritoneum. 
March  i8th,  1890. 


Rabbit. 
Died  June  2nd  (75  days  afterwards). 
Generalised  tubercidosis  of  peritoneum,  me- 
senteric glands,  liver,  spleen,  kidneys, 
and  lungs. 


Guinea-pig. 

Killed  August  3rd  (138  days  afterwards). 

Two  or  three  gramdations  in  the 

liver  and  spleen. 


540 


CLINICAL   VETERINARY    MEDICINE    AND    SURGERY. 


FOWL    V. 

Tiiberculosis  of  the  liver  and  spleen. 
April  17th,  1890. 

Rabbit. 

Killed  August  3rd  (108  days  afterwards). 

Tubercles  in  the  epiploon  ;  a  few  granules  in  the  liver  and  spleen. 

I 

Guinea-pig. 

Killed  March  20th,  189 1  (229  days  afterwards). 

No  lesion. 

FOWL  VL 

Tuberculosis  of  the  liver  and  spleen. 

June  i6th,  1890. 


I 

Guinea-pig. 

Killed    October   5th 

(i  1 1  days  afterwards). 

No  lesion. 


Guinea-pig. 

Died  November  27th 

(164  days  afterwards). 

No  lesion. 


Rabbit. 
Died  August  24th 
(69  days  afterwards). 
Generalised  tubercu- 
losis of  peritoneum, 
liver,  spleen,  kidneys, 
a7id  lungs. 
I 


Rabbit. 
Died  February  7th, 
1 89 1  (236  days  after- 
wards). 
White  swellings  ;  some 
tubercles  in  the  liver, 
kidneys,  and  lungs. 


Rabbit. 
Died  November  24th  (93  days 
afterwards). 
Generalised  tuberculosis  of  perito- 
neum, liver,  pleurce,  and  hmgs. 


Guinea-pig. 

Died  March  20th,  1891  (208 

days  afterwards). 

No  lesion. 


FOWL  VII. 

Tuberculosis  of  the  intestine,  peritoneum,  liver,  and  spleen. 

July  6th,  1890. 


I  I                      ^  1 

Fowl.  Fowl.''  Guinea-pig. 

Died  October  7th   (93  days  Died  August  24th  (49  days  Died    November  29th    (146 

afterwards).  afterwards).  days  afterwards). 

Tuberculosis     of    the     liver,  Ascites  ;  tubercidosis  of  the  Abscess  at  the  point  of  inocu- 

spleeyi,  and  peritoneum.  liver  and  spleen,  lation. 

I 

Fowl. 

Died  November  20th  (88  days  afterwards). 

Tubercidosis  of  the  liver,  spleen,  peritoneum,  and  kidneys. 

I 

Fowl. 

Killed  March  20th,  1891  (120  days  afterwards). 

Discrete  tubercles  in  the  spleen  and  peritoneum. 


Fowl. 

Died  June  15th  (87  days  afterwards) 

Tuberculosis  of  the  liver,  spleen,  peritoneum, 

and  lungs  ;  fibrinous  ascites. 

FOWL  VIII. 

Tubercidosis  of  the  intestine  and  liver, 

November  6th,  1890. 

I 


Guinea-pig. 

Killed  July  12th  (114  days  afterwards). 

A^o  lesion. 


Horse.* 
Killed  January  7th,  1891  (62 
days  afterwards). 
No  lesion. 


Guinea-pig. 

Killed  July  2nd,  1891  (248 

days  afterwards). 

Large  hepatic  abscess. 


Guinea-pig. 

Died  December  8th  (32  days 

afterwards). 

No  lesion. 


AVIAN    TUBERCULOSIS. — EXPERIMENTAL   STUDY. 


541 


PHEASANT. 

Ascites  ;   tuberculosis  of  the  intestine,  liver,  and  spleen. 
December  14th,  1889. 


I 

Fowl. 

Died  January  25th,  1890  (42  days  afterwards). 

Ascites;  tuberculosis  of  the  peritoneum, 

liver,  and  spleen. 


Fowl. 
Killed   February   2nd,   1890  (50  days  after- 
wards). 

Tuberculosis  of  the  peritoneum  atid  liver. 


I 

Guinea-pig. 

Killed  June  8th    (135    days 

afterwards). 
Abscess  at  point  of  inocula- 
tion. 


GUINE.\-PIG. 

Died    May   9th  (103  days 

afterwards). 
Ascites  ;  generalised  tuber- 
culosis {liver)  spleen,  lungs). 


Guinea-pig. 

Died    March    4th    (30    days 

afterwards). 

No  lesion. 


GUINEA-PIG. 

Killed  September  8th. 
Five  or  six  granidations  in  the  liver  and  lungs. 


GuiNEA-piG.  Rabbit. 

Died  December  25th  (109  days  afterwards).        Killed  January  24th,  1891   (139  days  after- 
A  few  granidations  in  the  liver.  wards). 

Tuberculosis  of  the  lungs,  kidneys,  and 
mesenteric  glands. 


Guinea-pig.  Fowl.  Fowl. 

Killed   July   I2ch   ("169  days  Killed  July  12th  (169  days  Killed  July   19th   (176  days 
afterwards).                                     afterwards).  afterwards). 

Generalised  tuberculosis  {liver  No  lesion.  No  lesion, 

[cirrhoticl ,  spleen , per  itoneum , 
and  lungs). 


PHEASANT. 

Ascites,  tubercidosis  of  intestine,  liver,  and  spleen. 
December  15th,  1889. 


Guinea-pig. 
Killed  June  8th,  1890  (165  days  afterwards). 
A  few  pulmonary  tubercles. 


GUINEA-FOWL. 

Tuberculosis  of  the  liver  and  spleen. 

March  9th,  1890. 

\ 

I  I 

Guinea-pig.  Guinea-pig. 

Killed  July  20th  (121  days  afterwards).  Killed  July  20th  (121   days   after- 

A  few  granidations  in  the  peritoneum,  liver,  wards). 

and  spleen.  Three  or  four  granidations  in  the 

I  epiploon. 

I  i 

Guinea-pig.  Guinea-pig. 

Killed   F'ebruary  15th,   1891  (210  days         Died  November  29th  (129  days 
afterwards).  afterwards). 

No  lesion.  No  lesion. 


542 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY 


Summary  of  Inoculation  Experiments  on  the  Guinea-pig. — In  sum- 
marising the  results  obtained  by  inoculating  guinea-pigs  with  avian 
tuberculosis  the  animals  may  conveniently  be  classified  into  four 
groups  : — (i)  Those  in  which  the  autopsy  showed  no  appreciable 
lesion ;  (2)  those  in  which  a  caseous  abscess  was  found  at  the  point 
of  inoculation;  (3)  those  which  showed  a  few  visceral  tubercles;  and 
(4)  those  in  which  the  disease  became  generalised  and  revealed  itself 
by  an  outbreak  of  tubercles  sometimes  as  abundant  as  when  human 
tuberculous  material  is  used  for  inoculation. 

These  different  results  are  given  in  the  table  hereafter.  In  each 
group  the  animals  have  been  divided  into  two  categories — those  which 
died  spontaneously,  and  those  which  were  killed.  In  each  of  these 
again  we  have  noted  how  long  the  animal  lived  after  inoculation. 


No  Lesion. 

Loc.-^L  Abscess. 

Discrete  Viscer.\l  Tubercu- 
losis. 

Gener.'^lised 
Tuberculosis. 

Animals 
which 
died. 

Days. 

Animals 
killed. 

Animals 
which 
died. 

Animals 
killed. 

Animals 
which 
died. 

Animals 
killed. 

Organs 
affected. 

Animals    «    •       1 
,  .  ,       Animals 
which       ,  .,,  J 

died.         ^'^^^^- 

1 

Days. 

Days. 

Days. 

Days. 

Days. 

Days.        Days. 

16 

Ill 

— 

135 

109 

— 

Liver. 

I 03            I 69 

30 

114 

— 

— 

— 

121 

Peritoneum. 

—       '       — 

37 

140 

146 

— 

121 

Liver  and 
spleen. 

1       — 

129 

165 

— 

— 



138 

Id. 

— 

— 

164 

208 

— 

— 

141 

Liver  and 
lungs. 

— 

210 

— 

— 

— 

158 

Lungs. 

— 

— 

229 
248 

— 

— 

— 

165 

Id. 

— 

— 

5  cases 

8  cases 

I  case 

I  case 

I  case 

6  cases 

I  case 

I  case 

1.                           ' 

1.                           > 

V 

V                                         /      1 

13  cases,  or  54 

2  cases  or  8  per 

7  cases 

,  or  29 

2  cases,  or  8  per 

percent. 

cent. 

per  c 

;ent. 

cent. 

Successive  Inoculation  with  Avian  and  Human  Tuberculosis. — We 
might  add  to  the  experiments  already  described  many  others  consisting 
of  inoculating  guinea-pigs  with  cultures  of  avian  tuberculosis. 
Certain  animals  resisted,  a  fact  which  enabled  us  to  undertake  the 
study  of  a  fresh  problem,  viz.  whether  after  such  inoculation  any  modi- 
fication occurred  in  the  animal's  receptivity  to  human  tuberculosis. 

On  the  25th  March,  1890,  we  injected  a  guinea-pig  intra-peritone- 
ally  with  a  certain  quantity  of  avian  culture.     On  the  igth   October, 


AVIAN    TUBERCULOSIS.  —  EXPERIMENTAL    STUDY.  543 

that  is  to  say,  at  the  end  of  200  days,  this  animal,  which  had 
continued  in  excellent  health,  was  killed.  On  post-mortem  examina- 
tion two  encysted  caseous  abscesses  were  found  in  the  epiploon  ;  one 
the  size  of  a  pea,  the  other  of  a  small  nut.  The  pus  from  these 
abscesses,  which  contained  very  large  numbers  of  bacilli,  was 
used  for  the  intra-peritoneal  injection  of  three  guinea-pigs  and  a 
fowl. 

The  latter  remained  in  good  health,  and  was  destroyed  on  the 
gth  April,  i8gi,  that  is  at  the  end  of  172  days.  At  the  site  of  each 
injection  was  a  yellowish  flattened  mass,  as  large  as  an  almond, 
formed  of  fibrous  tissue,  in  the  centre  of  which  were  seen  round  and 
fusiform  cells  and  hyaline  masses.  Although  we  were  unable  to  dis- 
cover bacilli  on  section,  we  regarded  this  growth  as  tuberculous,  and 
similar  in  character  to  the  rice-like  grains  of  certain  cysts.  But  even 
rejecting  this  interpretation,  the  fact  none  the  less  shows  that  during 
their  six  months'  sojourn  in  the  organism  of  a  guinea-pig  the  bacilli 
had  become  incapable  of  producing  an  outbreak  of  tubercle  in  the 
fowl.  We  cannot  help  comparing  the  above  result  with  that  obtained 
by  passing  the  tuberculosis  of  the  pheasant  through  three  mammals. 
The  reader  will  remember  that  in  this  case  the  virus  was  greatly 
modified,  and  that  it  became  incapable  of  killing  members  of  the 
Gallinaceae. 

Of  the  three  guinea-pigs  inoculated  simultaneously  with  the  fowl, 
two  died  rapidly  in  sixteen  and  twenty  days,  as  sometimes  occurs  after 
inoculation  with  avian  cultures.  Autopsy  only  revealed  a  small  local 
lesion  at  the  point  of  injection.  The  third  bird  appeared  in  good 
health  on  the  12th  March,  1891,  five  months  after  inoculation  ;  some 
drops  of  an  emulsion  prepared  with  the  liver  of  a  guinea-pig,  which 
had  died  from  inoculated  human  tuberculosis,  were  then  injected  into 
the  abdominal  cavity.  The  animal  died  on  the  3rd  July,  1891.  At  the 
autopsy  caseous  infiltration  of  both  lungs  was  noted.  The  spleen, 
which  measured  three  inches  in  length  and  one  and  a  half  inches  in 
breadth,  appeared  red,  and  dotted  over  with  white  points;  the  hver 
was  large,  and  had  a  "nutmeg"  appearance.  Histological  examina- 
tion showed  extremely  extensive  tuberculous  infiltration. 

Here,  then,  was  a  guinea-pig  which  had  perfectly  resisted  inoculation 
wath  avian  tuberculosis,  but  had  in  no  sense  become  immune  against 
human  tuberculosis.  It  died  as  rapidly  as  the  two  control  guinea-pigs 
inoculated  simultaneously. 

With  this  we   may  compare  another  precisely  similar  experiment. 

On  the  2ist  January,  1891,  we  inoculated  two  guinea-pigs  with  a 
culture  of  avian  tuberculosis  ;  they  remained  in  good  health.    One  was 


544  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

injected  on  the  12th  March,  the  other  on  the  12th  April,  with  human 
tuberculosis  ;  the  first  died  on  the  2nd  July  and  the  second  on  the  15th. 
In  both  we  found  generalised  visceral  tuberculosis  precisely  like  that 
which  follows  inoculation  with  human  tuberculosis. 

These  experiments  may  be  summed  up  as  follows  : — Six  guinea-pigs 
received  avian  cultures  ;  two  died  rapidly,  without  showing  visceral 
lesions  on  post-mortem  examination;  four  resisted,  three  of  which  were 
afterwards  inoculated  with  human  tuberculosis.  The  latter  behaved 
as  though  previously  healthy.  Without  wishing  to  draw  a  final  con- 
clusion from  these  three  experiments  we  think  it  allowable  to  conclude 
that  previous  inoculation  with  avian  tuberculosis  neither  favours  nor 
impedes  the  development  of  human  tuberculosis. 

To  summarise  the  facts  established  in  this  first  portion  of  our 
research,  we  have  only  to  reproduce  in  their  entirety  the  propositions 
formulated  at  the  end  of  our  previous  note  on  avian  tuberculosis. 

Tuberculosis  of  Gallinacese  is  transmissible  to  fowls.  Intra-venous 
or  intra-peritoneal  inoculation  is  followed  by  the  development  of 
generalised  and  rapidly  fatal  tuberculosis. 

The  rabbit  readily  contracts  avian  tuberculosis,  at  least  when 
bacilli  are  introduced  into  the  peritoneum  ;  death  follows  in  two  or 
three  months  from  generalisation  of  the  infection. 

The  guinea-pig,  though  more  sensitive  to  human  tuberculosis  than 
the  rabbit,  is  much  more  resistant  than  it  to  avian  tuberculosis. 
Inoculation  rarely  produces  general  infection.  In  almost  all  the  cases 
(gi  per  cent.)  either  the  animals  show  no  lesion  of  tuberculosis  (54  per 
cent.),  or  they  show,  at  the  point  of  inoculation,  a  caseous  abscess 
which  persists  for  a  longer  or  shorter  time  (8  per  cent.)  ;  or  visceral 
infection  occurs  (29  per  cent.),  the  tubercles  remaining  partial  and 
discrete,  and  tending  towards  fibrous  transformation  and  recovery. 

Part  2. — Inoculation  of  the  Gallinacece  with  Mammalian  Tuberculosis. 

Having  shown  the  manner  in  which  avian  tuberculosis  behaves 
when  inoculated  into  animals,  it  now  becomes  necessary  to  approach 
the  converse  problem,  and  to  discover  if  mammalian  tuberculosis  can 
be  conveyed  to  birds. 

We  have  already  remarked  that  authors  who  have  studied  this 
question  are  far  from  agreeing.  Although  Bollinger,  Koch,  and 
Nocard  were  able  to  transmit  human  tuberculosis  to  the  Gallinaceae, 
the  majority  of  pathologists  have  had  negative  results.  Villemin, 
H.   Martin,   Straus    and    Wurtz,    Riffi    and    Gotti,   Rivolta,    Maffucci, 


AVIAN    TUBERCULOSIS.  —  EXPERIMENTAL    STUDY.  545 

Straus  and  Gamaleia  were  unable  to  convey  mammalian  tuberculosis  to 
fowls;  and  M.  Nocard  had  no  greater  success  in  a  fresh  series  of 
experiments. 

We  have  further  pursued  the  study  of  this  question.  We  inoculated 
thirty-nine  fowls  and  a  pheasant  with  tuberculous  material  obtained 
from  man  and  from  various  mammals. 

Inoculation  with  Human  Tuberculosis. — In  most  of  our  experiments 
we  employed  pulmonary  tuberculous  material,  choosing  recent  un- 
softened  centres,  so  as  to  obtain  a  pure  lesion  and  to  avoid  injecting 
mixtures  of  microbes. 

(i)  In  the  first  series  of  experiments  we  directly  inoculated  a  guinea- 
pig  and  two  fowls  with  human  tuberculosis ;  the  guinea-pig  died  in 
twenty-eight  days  with  classical  generalised  tuberculosis ;  a  fowl 
inoculated  in  the  peritoneum  was  killed  at  the  end  of  211  days;  its 
viscera  appeared  healthy,  and  inoculation  of  a  fragment  of  its  liver  into 
a  guinea-pig  produced  no  appreciable  disturbance.  The  results  in  the 
second  fowl,  which  was  intra-venously  inoculated,  were  very  different. 
This  fowl  was  killed  at  the  end  of  forty-two  days,  when  it  appeared  in 
perfect  health.  We  were,  therefore,  exceedingly  surprised  to  find  in  its 
liver  and  spleen  a  considerable  number  of  extremely  minute  granula- 
tions ;  they  consisted  of  greyish,  semi-transparent  tubercles,  evidently 
of  recent  date.  This  discovery  alone  seemed  to  show  that  the  tuber- 
culosis was  not  spontaneous  in  character ;  if  the  changes  had  existed 
prior  to  our  inoculation  they  would  have  presented  an  entirely  different 
aspect.  As  we  before  showed,  one  often  finds  in  such  cases  large 
yellowish  masses,  not  a  crowd  of  greyish  granulations.  But  if  any 
doubt  remain,  it  should  be  dissipated  by  the  results  of  inoculations 
made  with  the  liver  of  this  fowl.  An  emulsion  of  the  liver  was  injected 
into  the  peritoneal  cavities  of  a  guinea-pig  and  a  fowl ;  the  guinea-pig 
died  in  seventy-two  days  of  generalised  tuberculosis ;  the  fowl  was 
killed  at  the  end  of  207  days,  but  its  organs  remained  healthy.  This 
experiment  appeared  to  us  absolutely  conclusive.  We  were  dealing 
with  human  tuberculosis,  and  the  bacillus  which  had  in  the  first  fowl 
produced  tuberculous  granulations  had  preserved  its  specific  properties: 
inoculated  into  a  second  fowl  it  failed  to  produce  tubercles,  which  would 
certainly  have  developed  had  we  been  dealing  with  an  accidental  avian 
tuberculosis.  This  fact  alone  sufficiently  demonstrates  that  the  bacillus 
of  human  tuberculosis  may  sometimes  produce  visceral  granulations  in 
the  fowl. 

As  before,  w^e  summarise  the  results  of  the  experiments  in  tabular 
form,  so  that  the  series  of  inoculations  may  more  easily  be  followed. 

M  M 


546 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


The  asterisks  indicate  animals  which  were  intra-venously  injected  ;   the 
others  were  inoculated  intra-peritoneally. 


MAN. 

Pulmonary  tuberculosis. 

August  24th,  1890. 


Guinea-pig. 
Died     September    21st     (28 

days  afterwards). 
Ascites ;    tuberculosis  of  the 
peritoneum,  liver,  and  spleen. 


Fowl.* 
Killed     October    5th     (42 

days  afterwards). 
Very    numerous    and   very 
S7nall  granulations  in  the 

liver  and  spleen. 


Guinea-pig. 
Died  December  16th  (72  days 

afterwards). 
Generalised  tubercidosis  {peri- 
toneum,   liver,    spleen,    and 
lungs). 


Fowl. 
Killed    April    30th 
(207     days     after- 
wards). 
No  lesion. 


I 

Fowl. 

Killed  March  24th,  1891  (211 

days  afterwards). 

No  lesion. 


Guinea-pig. 

Killed  July   12th    (no   days 

afterwards). 

No  lesion. 


(11)  Most  of  the  fowls  were  inoculated  with  human  material,  which, 
however,  had  been  passed  through  the  guinea-pig. 

Twenty-three  fowls  were  used  in  these  experiments  :  fifteen  received 
the   virus   intra-venously;    three    intra-peritoneally;    and   five    simul- 


FiG.  77. — Tuberculosis  of  the  liver,  produced  by  inoculation  with  human  virus. 

taneously  in  the  veins  and  in  the  peritoneum.  None  of  these  ani- 
mals died  ;  all  were  killed  at  the  end  of  a  period  varying  between  eleven 
and  266  days.  On  post-mortem  examination  we  only  found  tuberculous 
lesions  in  three  fowls.     These  three  belonged  to  the  third  series  com- 


AVIAN    TUBERCULOSIS.  —  EXPERIMENTAL    STUDY.  547 

prising  five  animals  w^hich  had  been  simultaneously  inoculated  in  the 
veins  and  peritoneum  with  an  emulsion  of  guinea-pig's  liver.  The  first 
of  these  five  fowls  was  killed  at  the  end  of  eleven  days  ;  its  organs 
were  unaffected.  The  second,  killed  at  the  end  of  twenty-four  days, 
showed  no  visceral  lesion,  but  the  bacilli  of  human  tuberculosis  were 
still  present  in  its  liver,  for  inoculation  of  a  guinea-pig  with  fragments 
of  the  organ  produced  typical  tuberculosis.  The  third  was  killed  on 
the  thirty-fifth  day  ;  it  was  rather  thin  :  on  post-mortcni  examination 
sero-fibrinous  ascites  was  noticed  ;  the  liver  was  slightly  enlarged,  and 
crammed  with  extremely  small  tuberculous  granulations ;  the  spleen 
was  also  slightly  enlarged,  but  contained  no  granulations.  The  fourth, 
killed  on  the  thirty-eighth  day,  also  showed  numerous  granulations  in 
the  liver  and  on  the  mesentery.  The  fifth  was  killed  at  the  end  of 
fifty-nine  days ;  in  it  the  lesions  were  less  marked ;  somewhat 
numerous  but  small  tubercles,  practically  similar  to  those  seen  in 
the  fowl,  directly  inoculated  with  human  tuberculosis,  had  developed 
in  the  liver. 

With  tuberculous  material  from  the  fowl  killed  at  the  end  of  thirty- 
five  days  we  inoculated  another  fowl,  which  remained  in  good  health. 
It  was  killed  at  the  end  of  eighty-six  days  ;  we  found  ascites  and  small 
granulations  in  the  liver  and  spleen. 

All  these  facts  are  given  in  the  following  tables  : 

MAN. 

Pulmonary  tuberculosis. 

August  24th,  1890. 

I 

Guinea-pig. 

Died  September  21st  (28  days  afterwards). 

Ascites  ;  tuberculosis  of  the  peritoneum,  liver,  and  spleen. 


I  I 

Guinea-pig.  Fowl. 

Killed  October   iSth   (28  days  after-  Killed    March    20th,    1891   (180  days 

wards).  afterwards). 

Tuberculosis  of  the  peritoneum,  liver.  No  lesion, 

and  spleen. 


Fowl.*                                          Fowl.  Guinea-pig.  • 
(Reincculated  March   i8th.)           (Reinoculated  March  Killed     November    2nd, 
Killed  July   12th,  1891   (266                          13th.)  1890  (15  days  afterwards), 
and  121  days  afterwards).             Killed  July  12th,  1891  Tuberculosis  of  the  peri- 
No  lesion.                           (266  and  121  days  after-  toneum,  liver,  and  spleen. 

wards).  I 

No  lesion.  \ 

I  \  n  I 

Guinea-pig.  Fowl.'"  Fowl.'^  Fowl. 

Died  November  28th,  Killed  January  24th,  Killed    July     12th  Killed  July  I2th  (252 

1890  (26  days).  1891  (83  days).  (252  days).  days). 

A  few  tubercles  in  the  No  lesion.  No  lesion.  No  lesion, 

spleen. 


548 


CI-INICAL   VETERINARY    MEDICINE    AND    SURGERY, 


GUINEA-PIG. 

Generalised  tuberculosis. 
Killed  March  13th,  1891. 


Guinea-pig. 
Killed  May  6th 

(54  days). 

Generalised 
tubercidosis. 


Fowl.* 

Killed  March 

24th  (11  days). 

No  lesion. 


Guinea-pig. 
Died  May  25th  (19 

days). 
Generalised  tuber- 
culosis. 


Fowls. 


Fowl.* 

Killed   April 

6th  (24  days). 

No  lesion. 


Guinea-pig. 
Killed  July  12th 

(97  days). 
Tubercidosis  of 


Fowl.* 

Killed  April 

17th  (35  days). 

Ascites;  granu- 

lafions  in  the 

liver. 

1 
Killed  July  12th 

(86  days). 
Ascites  ;  tuber - 


Fowl.* 
Killed  April 
20th  (38  days). 
Granulations 
on  the  perito- 
neum and  in 
the  liver. 


I 

Fowl.* 

Killed  May  nth 

(59  days). 
Very  small  tu- 
bercles in  the 
liver. 


the  liver,  spleen,        culosis  of  the 
and  lungs.  liver  and  spleen. 

I.  Killed  May  22nd  (16  days).  No  lesion. 
II.  Killed  May  30th  (24  days). 

III.  Killed  June  7th  (31  days).  ,, 

IV.  Killed  June  15th  (39  days).  ,, 
V.  Killed  June  22nd  (46  days).  ,, 

VI.   Killed  July  ist  (55  days).  „ 

VII.  Killed  July  9th  (63  days). 
VIII.  Killed  July  17th  (71  days). 

IX.  Killed  July  19th  (73  days).  „ 

X.   Killed  July  26th  (80  days). 
XI.  Killed  Sept.  14th  (131  days).         ,, 
XII.       _  —  _  — 


Of  the  first  five  fowls  inoculated  in  this  last  series,  three  showed 
tuberculous  lesions  on  post-mortem  examination.  When  these  results 
were  laid  before  the  Societe  de  Biologic  various  objections  were  made, 
the  chief  of  which  are  as  follows  : — ( i)  The  best  evidence  of  the  immunity 
of  fowls  against  human  tuberculosis  is  to  be  found  in  the  fact  that  none 
died  spontaneously ;  (2)  we  were  wrong  in  not  using  cultures  for  our 
inoculations ;  (3)  we  had  mistaken  for  tuberculosis,  nodular  lesions 
produced  by  the  injection  of  emulsified  tuberculous  material ;  (4)  we 
should  have  experimented  on  fowls  already  affected  with  avian  tuber- 
culosis. 

To  the  first  objection  we  reply,  that  if  none  of  our  fowls  died  spon- 
taneously it  was  for  the  simple  and  decisive  reason  that  we  killed  them. 

To  the  second,  that  of  the  various  methods  of  inoculation  with 
human  tuberculosis  (direct  inoculation,  or  inoculation  with  cultures 
prepared  in  living  animals,  or  on  inert  media),  we  consider  that  none 
is  superior  to  the  others  unless  it  give  better  results. 

To  the  third,  that  histological  and  bacteriological  examination 
clearly  proved  the  tuberculous  nature  of  the  lesions  noted. 

Finally,  in  order  to  refute  the  last  objection,  we  shall  not  shelter 
ourselves  behind  the  assurance  of  the  person  who  furnished  us  with  the 


AVIAN   TUBERCULOSIS. — EXPERIMENTAL   STUDY,  549 

animals,  that  tuberculosis  had  never  occurred  in  his  fowl  run,  and 
that  during  the  previous  four  years  no  contagious  disease  had  occurred 
there  ;  but  draw  attention  to  the  fact  that  two  fowls  killed  respec- 
tively eleven  and  twenty-four  days  after  inoculation  were  free  of  any 
visible  tubercle,  whilst  the  last  three  fowls,  killed  thirty-five,  thirty- 
eight,  and  fifty-nine  days  after  inoculation,  had  become  tuberculous. 

In  these  three  fowls  the  tubercles  were  small,  greyish,  and  trans- 
parent, unquestionably  recent.  On  histological  examination  they  were 
seen  to  be  composed  of  simple  epithelioid  nests  without  trace  of 
degeneration.  Our  sections  showed  in  an  absolutely  unanswerable 
way  that  the  granulations  of  the  fowl  inoculated  with  human  tubercu- 
losis, and  killed  on  the  35th  day,  were  less  advanced  in  their  develop- 
ment than  those  of  the  fowl  inoculated  with  avian  tuberculosis,  which 
died  on  the  thirty-ninth  day. 

We  are,  therefore,  convinced  that  the  tuberculosis  was  the  result 
of  inoculation. 

But  the  fact  which  seems  to  us  most  important  is,  that  human 
tuberculosis  could  be  transmitted  from  one  fowl  to  another  ;  the  lesions 
were  well  marked,  notwithstanding  which  this  animal,  like  the  preced- 
ing, seemed  little  affected  by  the  presence  of  these  visceral  granula- 
tions ;  it  had  not  lost  flesh  in  the  least,  and  we  were  exceedingly 
surprised  at  the  result  of  the  post-mortem.  Thus,  in  the  same  way  that 
avian  tuberculosis  may,  in  mammals,  produce  growths  of  minute 
tubercles  without  interfering  with  general  health,  and  without  causing 
emaciation,  human  tuberculosis  may  in  the  fowl  produce  specific 
lesions,  which  are  very  well  tolerated. 

(hi)  We  have  to  record  a  third  series  of  experiments,  in  which  we 
utilised  the  caseous  magma  from  a  case  of  tuberculosis  of  the  testicle. 
It  seemed  interesting  to  utilise  this  local  lesion,  for  a  virus  attenuated 
for  man  might  very  well  be  more  active  for  the  fowl. 

With  the  material  from  this  tuberculous  testicle  we  inoculated  four 
fowls,  one  pheasant,  and  two  guinea-pigs.  The  guinea-pigs  died  from 
visceral  tuberculosis,  in  fifty-four  and  fifty-six  days  respectively.  The 
birds  all  resisted,  and  when  killed,  after  an  interval  varying  between 
62  and  248  days,  their  viscera  showed  no  appreciable  changes. 

These  results  are  indicated  in  the  following  table.  It  will  be  seen 
that  we  inoculated  a  guinea-pig  with  the  liver  of  a  fowl  killed  at  the 
end  of  seventy-two  days.  The  result  was  negative.  The  bacilli  had 
therefore  been  destroyed,  or  changed  by  their  sojourn  of  two  and  a 
half  months  in  the  body  of  the  fowl. 


55° 


CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 


MAN. 

Tuberculosis  of  the  testicle. 

November  13th,  1890. 

I 


Guinea-pig. 

Died  January 

6th,  1891  (54 

days). 

Tuberculosis  of 
the  spleen. 


Guinea-pig. 
Died  January 
8th  (56  days). 

Tuberculosis 

of  the  spleen 

and  liver. 


I 
Fowl.* 
Killed  Jan- 
uary 24th  (72 
days). 
No  lesion. 


Fowl.* 

Died  April 

loth  (149 

days). 

No  lesion. 


Fowl. 
Killed  Jan- 
uary 24th  (72 

days). 
No  lesion. 


Fowl. 

Killed  July 

19th  (248 

days). 
No  lesion. 


Pheasant. 
Killed  January 
1 6th  (62  days). 

No  lesion. 


Guinea-pig. 

Killed  July  12th  (169  days). 

No  lesion. 

Summarising  the  facts  noted  after  inoculating  members  of  the 
Gallinacese  with  human  tuberculosis,  the  results  are  as  follows  : 

Thirty-two  fowls  were  inoculated  with  tuberculous  material  derived 
directly  from  man,  or  having  passed  through  other  animals ;  on  post- 
mortem examination  five  showed  visceral  granulations ;  in  all  inocula- 
tions tuberculosis  had  been  produced,  i.  e.  tuberculosis  resulting  from 
human,  and  not  from  avian  bacilli.  Even  though  objection  might  be 
made  regarding  the  second  series  of  experiments,  no  doubt  seems 
possible  concerning  the  fowl  in  which  the  granulations  proved  inocu- 
lable  to  the  guinea-pig  and  to  another  fowl.  In  these  cases  the  bacillus 
had  preserved  its  original  characteristics,  and  the  nature  of  the  infection 
appeared  to  us  absolutely  proved. 


Inoctdation  with  Bovine  Tuhercidosis. — We  were  not  content  to 
inoculate  with  human  tuberculosis  alone,  but  utilised  tuberculous 
material  from  different  mammals,  and  particularly  from  animals  of  the 
bovine  species  ;  such  a  test  appearing  more  important  on  account  of 
the  doubts  which  have  recently  been  thrown  on  the  identity  of 
pulmonary  tuberculosis  in  animals  and  human  tuberculosis.  Fowls 
remained  unaffected  whilst  the  disease  was  transmitted  to  the  rabbit, 
guinea-pig,  and  cat. 

COW. 

Pleural  and  pulmonary  tuberculosis. 


November  4th,  1889. 
1 

Guinea-pig. 

Guinea-pig. 

1 
Guinea-pig. 

1 
Rabbit. 

1 

Rabbit. 

1 
Fowl. 

Died  Novem- 

Died Novem- 

Died Novem- 

Died Novem- 

Died Novem- 

Killed March 

ber  20th  (16 

ber  27th  (23 

ber  27th  (23 

ber  17th  (13 

ber  29th  (25 

20th,  1890 

days). 

days).  _ 

days). 

days). 

days). 

(136  days). 

Afe7v  tttbercles 

Tuberculosis 

Tuberculosis 

Afeiv  tubercles 

Tuberculosis 

No  lesion. 

on  the  perito- 

of the  spleen, 

of  the  liver. 

on  the  perito- 

of the  liver, 

neum. 

liver,  and 

spleen,  and 

neum  and  in 

spleen,  and 

peritoneum. 

peritoneum. 

the  liver. 

peritoneum. 

AVIAN    TUBERCULOSIS. EXPERIMENTAL    STUDY.  55  I 

OX. 

Pleural  and  pulmonary  tuberculosis. 
November  15th,  1889. 

I 

Cat. 

Died  November  i6th  (31  days). 

Generalised  tuberculosis . 

I 

Fowl. 

Killed  August  3rd,  1890  (230  days). 

No  lesion. 

OX. 

Pleural  and  pulmonary  tuberculosis. 
March  i8th,  1890. 

I 

Fowl. 

Killed  October  12th  (208  days). 

No  lesion. 

Inoculation  with  Tuberculous  Lesions  from  the  Dog,  Cat,  and  Horse. — 
Finally,  we  come  to  the  last  series  of  experiments  in  which  material  for 
inoculation  was  obtained  from  animals  which  rarely  suffer  from 
tuberculosis. 

In  the  first  the  virus  was  obtained  from  a  dog  with  tuberculosis  of 
the  lung  and  pleura.  From  a  pulmonary  centre  which  contained  large 
numbers  of  bacilli  we  inoculated  two  guinea-pigs  and  two  fowls.  The 
fowls  resisted,  while  the  guinea-pigs  died  with  all  the  ordinary  sym- 
ptoms of  tuberculosis. 

In  the  second  the  virulent  material  was  obtained  from  a  case  of 
pulmonary  tuberculosis  in  the  cat.  The  inoculation  was  successful  in 
the  guinea-pig,  but  failed  in  the  fowl.  What  renders  this  second  series 
interesting  is  that  the  virus  appeared  pathogenic  for  the  horse,  intra- 
venous inoculation  producing  death  in  twenty-four  days.  On  post- 
morteni  both  lungs  were  found  affected  with  miliary  tuberculosis,  the 
separate  points  being  extremely  small  and  confluent  ;  this  lesion  was  of 
surprising  intensity.  The  bacilli  inoculated  must  have  been  very 
virulent,  for  every  one  knows  that  the  horse  is  not  specially  sensitive  to 
tuberculosis.  We  therefore  supposed  that  the  virus,  rendered  still 
more  virulent  by  its  passage  through  the  horse,  would  have  developed 
in  the  fowl,  but  in  this  case  again  inoculation  was  unsuccessful,  the 
fowl,  on  being  killed  at  the  end  of  135  days,  showing  no  appreciable 

lesion. 

DOG. 

Pulmonary  tuberculosis. 

January  5th,  1891. 

\ 

III.' 
Guinea-pig.  Guinea-pig.  Fowl.*  Fowl. 

Died  February  13th  Died  February  23rd        Killed   April    i6th         Killed  July  19th  (195 

(39  days).  (49  days).                        (loi  days).                              days). 

Generalised  tubercu-  Generalised  tubercu-                No  lesion.                            No  lesion. 

losis  {liver,  spleen,  losis  {liver,  spleen, 

and  lungs).  and  lungs). 


552 


CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 


Guinea-pig. 

Died  February  2nd 

(13  days). 

A  feii}   granulations 

in  the  liver. 


CAT. 

Pulmonary  tuberculosis. 
January  20th,  189 1. 


Horse.* 
Died  February  13th 

(24  days). 

Miliary  tuberculosis 

of  the  lungs. 


Fowl.* 

Killed  June  28th 

(159  days). 

No  lesion. 


Fowl. 
Killed  June  28th  (159 

days). 
No  lesion. 


Summary  of  the  Attempts  to  inoculate  Gallinacecs  with  Mammalian 
Tuberculosis. — Forty  members  of  the  Gallinacese  were  inoculated  with 
mammahan  tuberculosis ;  none  died  spontaneously  ;  all  were  killed 
after  a  varying  period.  On  post-mortem  examination  tuberculosis  was 
found  in  five,  but  in  thirty-five  no  lesion  could  be  detected. 

The  results  obtained  are  indicated  in  the  following  table,  which 
summarises  all  this  portion  of  our  experiments. 


Man 


Imonary 
berculosis 


Tuberculosis 
of  the  testicle 


/    Pu 

1    tub 


I 

{ 
Dog  I  P;'i"io"a'-y    r 

°     L  tuberculosis     i 

{ 


Ma 


Oxen  i    Pulmonary 

^^^^   I  tube        '     ■ 

monary 

berculosis 


Cat    i    Pulmonary 
I  tut 


J  berculosis 


Method  of  inoculation. 


Results. 


Number 
of  animals 
inoculated.  Negative.  Positive. 


Directly 

After  passage  through  guinea-pig 

After  passage  through  fowl 

Directly 

Directly 

After  passage  through  cat 

Directly 

Directly      . 

After  passage  through  cat 


2 

23 
2 


40 


I 

20 
I 

5 

2 


35 


Without  attempting  a  comparative  study  of  tuberculosis  in  the 
different  mammals,  we  would  draw  attention  to  the  fact  that  these 
experiments,  performed  with  material  from  bovines,  and  from  the  dog, 
cat,  and  horse,  may  be  cited  in  favour  of  the  unicity  of  tuberculosis. 
The  guinea-pigs  and  rabbits  died  in  the  same  way  as  when  inoculated 
with  human  tuberculosis.  Development  has  often  been  very  rapid,  for 
bovine  tuberculosis  killed  guinea-pigs  in  two  and  three  weeks,  and 
canine  tuberculosis  in  five  weeks. 

Persistence  of  the  Human  Bacillus  in  the  Organs  of  Gallinaccce. — 
Our   experiments,    and  those   published  by  other    investigators,  show 


AVIAN   TUBERCULOSIS. — EXPERIMENTAL   STUDY.  553 

that  mammalian  tuberculosis  can  only  be  transmitted  to  birds  by 
special  methods.  We  were  therefore  led  to  inquire  what  becomes 
of  the  bacillus  when  introduced  into  the  bodies  of  birds.  M.  Martin 
first  commenced  the  study  of  this  question.  He  collected  blood 
from  a  certain  number  of  fowls  which  he  had  intra-peritoneally 
injected  with  human  tuberculosis,  and  with  it  he  inoculated  guinea- 
pigs.  The  results  were  extremely  variable :  sometimes  blood  from 
fowls  inoculated  three  months  before  did  not  appear  virulent ;  some- 
times blood  from  birds  inoculated  six  or  even  seven  months  before  trans- 
mitted tuberculosis.  We  again  took  up  the  question,  but  thought  it 
better  to  utilise  the  liver  instead  of  the  blood,  as  the  microbes  become 
localised  in  the  viscera.  Our  experiments  gave  the  following  results  : 
— Fragments  of  liver  from  a  fowl  inoculated  twenty-four  days  before 
transmitted  tuberculosis  to  the  guinea-pig ;  fragments  of  the  same 
organ  injected  into  other  guinea-pigs  seventj^-two,  eighty-three,  and 
211  days  after  the  primary  inoculation,  produced  no  appreciable 
result. 

Thus  a  month  after  inoculation  with  human  tuberculosis  the  bacilli 
still  persisted  in  the  fowl's  organism  ;  at  this  time  they  seem  to  betray 
their  presence  by  certain  morbid  reactions  ;  the  fowls  often  become  ill 
towards  the  end  of  the  first  or  commencement  of  the  second  month 
after  inoculation  ;  this  fact  had  not  escaped  M.  Martin,  two  of  whose 
fowls  had  died  on  the  forty-seventh  and  forty-eighth  day,  though  the 
autopsy  was  negative.  Now  it  was  precisely  about  this  time  that  we 
noted  visceral  tuberculosis  (as  shown  in  the  table  below,  which  gives 
the  results  of  our  experiments). 

Results. 


Negative.  Positive. 

^  Between  the  nth  and  31st  days .          •     5          •            5          •  — 

Animals  killed    <  Between  the  35th  and  59th  days           .     7          .           3          .  4 

( Between  the  62nd  and  266th  days         .27          .          27         .  — 

Total 39         •         35         ■  4 

Speaking  generally,  there  was  no  tuberculosis  before  the  thirty-fifth 
or  after  the  fifty-ninth  day.* 

The  question  may  therefore  arise  whether,  towards  the  second 
month  after  inoculation,  lesions  may  not  be  produced,  which  though 
in  most  cases  only  appreciable  on  microscopic  examination,  would 
nevertheless  explain  the  symptoms  shown.  Histological  examination, 
carried  out  in  one  case,  did  not  support  this  hj'pothesis.     The  liver  of 

*  The  fowl  to  which  tuberculosis  of  human  origin  was  transmitted  after  passage  through 
other  fowls  forms  an  exception  ;  in  this  case  the  virus  may  have  .undergone  modification  by 
passage  through  the  previous  birds. 


554  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

a  fowl  killed  on  the  thirty-ninth  day  was  steatomatous,  but  contained 
no  granulations. 

To  sum  up,  inoculation  of  members  of  the  Gallinacese  with  mam- 
malian tuberculosis  seldom  proves  fatal.  In  most  cases  it  is  well 
borne ;  towards  the  second  month  it  sometimes  excites  certain  tem- 
porary disturbance ;  finally,  in  rare  cases  it  produces  a  crop  of  tuber- 
culous sfranulations  in  the  viscera. 


v.— SUMMARY    AND    CONCLUSIONS. 

Having  arrived  at  the  end  of  our  investigation,  we  think  it  well  to 
summarise  our  principal  conclusions. 

It  has  long  been  known  that  the  Gallinacese  suffer  from  a  disease 
resembling  tuberculosis,  characterised  by  the  production  of  granula- 
tions and  caseous  masses  of  varying  size.  These  lesions  especially 
affect  the  liver,  spleen,  and  peritoneum.  The  intestine  often  shows 
ulceration  ;  the  intestinal  contents  then  contain  bacilli,  which  serve  to 
transmit  disease  and  explain  certain  outbreaks. 

The  histological  characters  of  the  tubercles  differ  in  the  fowl  and  in 
the  pheasant.  In  the  fowl  the  tubercle  consists  of  a  clump  of  epi- 
thelioid cells,  the  central  portion  of  which  has  undergone  hyaline  necro- 
biosis, and  is  surrounded  by  a  border  of  special  cells.  In  the  pheasant 
the  lesion  is  at  first  formed  by  nests  of  epithelioid  cells,  the  central 
portion  of  which  afterwards  disappears  in  consequence  of  molecular 
degeneration ;  simultaneously  a  connective-tissue  ring  is  formed,  which 
undergoes  amyloid  degeneration,  and  surrounds  cavities  resembling 
blood-vessels. 

All  these  growths  contain  bacilli  presenting  the  same  appearance, 
and  behaving  to  colouring  agents  in  the  same  way,  as  those  found  in 
the  tuberculosis  of  man  and  of  other  mammals. 

Experiment  appeared  the  only  way  of  determining  the  connection 
between  tuberculosis  of  mammals  and  that  of  birds. 

Our  research  may  be  divided  into  two  parts. 

In  the  first  group  of  experiments  we  studied  the  avian  virus,  and 
found  that  it  is  readily  communicated  to  fowls.  Injected  into  the 
veins  or  peritoneal  cavity  it  produces  lesions  resembling  those  of 
spontaneous  tuberculosis. 

When  introduced  into  the  abdomen  of  the  rabbit  the  avian  behaves 
very  similarly  to  the  human  bacillus,  producing  a  generahsed  outbreak 
of  granulations  in  the  viscera. 

In  the  guinea-pig  the  results  are  more  variable.  We  inoculated 
twenty-seven  guinea-pigs  intra-peritoneally ;  thirteen  of  these  showed 


AVIAN    TUBERCULOSIS. SUMMARY    AND    OONCLUSIONS.  555 

no  appreciable  lesion  ;  five  showed  a  caseous  abscess  at  the  point  of 
inoculation ;  seven  a  few  discrete  visceral  granulations ;  and  three 
generalised  miliary  tuberculosis. 

In  passing  through  the  organism  of  mammals,  the  avian  virus  be- 
comes modified  and  loses  its  pathogenic  properties  for  the  fowl. 

In  a  second  series  of  experiments  we  injected  fowls  with  tuber- 
culous material  derived  from  man  and  from  different  mammals  (ox, 
dog,  cat,  and  horse).  Forty  fowls  were  inoculated,  either  in  the  veins 
or  in  the  peritoneal  cavity,  or  simultaneously  in  both.  None  died.  In 
five  we  found  recent  very  small  transparent  tubercles ;  they  were  due 
to  the  human  bacillus,  for  in  one  case  they  could  be  reinoculated  into 
the  guinea-pig,  but  could  not  be  transmitted  to  another  fowl  ;  the  virus 
had  therefore  preserved  its  original  properties.  In  another  case  the 
bacilli  became  more  markedly  modified,  and  the  lesions  could  be  re- 
inoculated  from  one  fowl  to  another. 

The  cases  we  have  described,  and  the  experiments  published  by 
other  observers,  indisputably  prove  that  profound  differences  exist  be- 
tween mammalian  and  avian  tuberculosis.  On  the  basis  of  the  results 
obtained,  the  following  comparison  may  be  established  between  the 
two  viruses. 

The  avian  bacilli  are  longer  and  more  granular ;  they  develop  more 
readily  on  artificial  culture  media,  and  grow  at  once  on  glycerine  agar. 
The  human  bacilli  only  grow  on  this  medium  after  having  several  times 
been  sown  on  serum. 

As  MM.  Straus  and  Gammeleia  have  well  shown,  cultures  of  the 
avian  bacilli  are  moist,  fatty  in  appearance,  wrinkled,  and  soft ;  those 
of  the  human  bacilli  are  dry,  scaly  or  warty,  dull  and  hard. 

The  avian  bacillus  grows  at  43°  C,  and  can  resist  a  temperature 
of  65°  C.  ;  the  human  bacillus  ceases  to  grow  at  41°  C,  and  dies  at 
65°  C. 

An  avian  culture  six  months  old  is  still  living,  and  can  still  be  re- 
planted. A  human  culture  loses  its  power  of  reproduction  in  six 
months  (Maffucci). 

Avian  tuberculosis  can  be  transmitted  to  fowls.  It  seldom  or  never 
produces  generalised  tuberculosis  in  the  guinea-pig,  and  cannot  be 
inoculated  in  the  dog.  Human  tuberculosis  can  only  exceptionally  be 
transmitted  to  fowls  ;  it  always  produces  generalised  tuberculosis  in  the 
guinea-pig,  and  can  readily  be  conveyed  to  the  dog. 

Such  are  the  differences  between  the  two  viruses,  and  it  must  be 
confessed  they  are  considerable.  But  are  they  sufficient  to  constitute 
a  radical  distinction  ?  and  must  we  regard  the  two  bacilli  as  belonging 
to  different  species  ? 


556  CLINICAL   VETERINARY    MEDICINE    AND    SURGERY. 

On  reconsidering  the  distinctive  characters  just  mentioned  we  see 
that  they  are  perhaps  less  marked  than  might  at  first  appear. 

The  general  characters  of  the  two  bacilli  are  the  same,  and  the 
reactions  they  produce  in  the  living  organism  are  similar.  In  reply 
to  the  objection  that  the  histological  characters  of  human  tubercle 
differ  from  those  of  tubercle  in  the  Gallinacese  we  may  point  to  the 
still  greater  difference  between  the  tubercles  of  the  fowl  and  of  the 
pheasant  ;  in  animals  equally  sensitive  to  both  viruses,  like  the  rabbit, 
the  histological  features  of  the  lesions  are  identical ;  there  is  the 
same  formation  of  nodules,  the  same  tendency  to  caseation. 

By  studying  the  morphology  of  the  two  microbes  they  are  seen  to 
be  very  similar ;  the  few  differences  which  have  been  noted  are  secon- 
dary, and  equally  marked  variations  are  observed  on  comparing  tuber- 
culous bacilli  from  different  members  of  the  same  species ;  in  man  it  is 
not  uncommon  to  find  certain  bacilli  longer  and  more  granular  than 
others.  On  the  other  hand,  both  in  avian  and  in  human  bacilli  the 
great  specific  characteristics  remain,  especially  the  staining  reactions, 
which  appear  to  us  of  infinitely  greater  importance  than  a  morpho- 
logical detail. 

Without  being  absolutely  identical,  cultures  of  the  two  bacilli  offer 
certain  analogies  ;  the  human  bacillus  can  grow  on  glycerine  media,  and 
in  this  respect  tends  to  resemble  the  avian  bacillus ;  even  though  it 
will  not  grow  immediately,  is  this  character  sufficient  to  establish  a 
fundamental  distinction  ?  Would  not  a  simple  variation  of  race  suffice 
to  explain  this  difference  ? 

We  might  make  similar  suggestions  regarding  the  other  differential 
characters,  but  we  hasten  to  consider  those  more  particularly  appro- 
priate to  our  investigation — we  mean  the  pathogenic  properties. 

It  is  certain  that  different  animals  do  not  react  in  the  same  way  to 
both  viruses;  in  this  connection  MM.  Straus  and  Gamaleia  lay  stress 
on  the  following  fact  which  they  have  discovered :  the  dog  readily 
contracts  human  tuberculosis,  but  is  proof  against  avian  tuberculosis. 
This  fact  is  of  considerable  interest,  but  is,  nevertheless,  in  our  estima- 
tion insufficient  to  establish  a  specific  distinction.  Equally  marked 
differences  often  exist  between  varieties  of  the  same  species  ;  the  anthrax 
bacillus  kills  the  rabbit,  while  the  first  anthrax  vaccine  is  without 
action  on  it.  To  continue  our  comparison  we  might  remark  that  from 
the  point  of  view  of  form  and  of  cultures  there  is  certainly  as  much 
difference  between  the  virulent  anthrax  bacillus  and  the  attenuated 
bacillus  as  between  the  bacillus  of  human  and  of  avian  tuberculosis. 

We  do  not  think  it  advisable  to  rely  on  one  or  two  differential 
characters  in  attempting  to  solve  this  question,  but  to  take  into  con- 


AVIAN    TUBERCULOSIS. — SUMMARY    AND    CONCLUSIONS.  557 

sideration  all  the  characteristics  of  the  two  microbes.  From  this 
point  of  view  we  should  bear  in  mind  that  a  number  of  facts  tend  to 
prove  a  community  of  nature  between  the  two  viruses.  The  rabbit, 
for  example,  contracts  avian  as  readily  as  human  tuberculosis,  at  least 
when  inoculated  intra-peritoneally.  Although  the  guinea-pig,  the  test 
par  excellence  for  human  tuberculosis,  usually  resists  the  avian  disease,, 
it  nevertheless  sometimes  dies  with  generalised  visceral  granulations. 
Conversely  the  fowl  is  not  absolutely  immune  against  human  virus  ; 
on  several  occasions  we  have  seen  tuberculous  lesions  produced  in  the 
fowl,  and  in  one  case  we  were  able  to  prove  that  the  lesions  were  due 
to  the  human  bacillus,  which  had  preserved  its  particular  characters. 

Finally,  we  have  cited  in  this  investigation  various  results  which 
tend  to  establish  that  the  two  viruses  may  undergo  modification,  and 
even  transformation  ;  in  one  case  human  tuberculosis  was  transmitted 
from  one  fowl  to  another  ;  in  another  avian  tuberculosis  by  passage 
through  mammals  became  exalted  in  virulence  for  these  animals,  but 
lost  its  pathogenic  properties  for  the  Gallinaceas. 

The  results  we  have  obtained,  and  those  reported  by  other  experi- 
menters, lead  us  to  think  that  the  two  bacilli  only  represent  two 
varieties  of  the  same  species.  Without  doubt  these  two  varieties  are 
very  different,  and  it  is  impossible  to  apply  to  one  results  obtained 
with  the  other.  To  prevent  a  recurrence  of  the  confusion  which  pre- 
viously obtained,  it  is,  therefore,  always  necessary  to  state  which  virus 
has  been  used.  But,  despite  their  very  important  distinguishing  charac- 
ters, a  common  basis  exists  on  which  these  two  pathogenic  agents 
may  be  compared  and  regarded  as  derived  from  a  single  source.  The 
view  which  we  think  best  agrees  with  hitherto  observed  facts  is  that 
tuberculosis  of  mammals  and  of  Gallinacese  are  essentially  one  and  the 
same. 


II.— TUBERCULOSIS  OF  PARROTS— ITS  RELATIONS 
TO  HUMAN  TUBERCULOSIS. 

By  MM.  Cadiot,  Gilbert,  and  Roger. 

When  Koch  discovered  the  bacillus  of  tuberculosis  it  was  hoped 
that  the  old  unending  dispute  between  the  unicists  and  the  dualists 
would  have  ended.  It  has  not  been  so ;  the  problem  has  only  been 
modified.  Doubt  no  longer  exists  of  the  unicity  of  tuberculosis  in 
man,  but  the  unicity  of  tuberculosis  in  animals  is  still  disputed. 
Some  authors  have  attempted  to  draw  a  sharp  line  of  demarcation,  an 
absolute  distinction,  between  the  pathogenic  agent  found  in  marhmals 
and  that  discovered  in  birds  ;  have  attempted,  in  fact,  to  prove  the 
existence  of  two  distinct  kinds  of  tuberculosis,  human  and  avian. 

The  question  has  more  than  a  theoretical  interest,  for  its  solution 
vitally  affects  hygiene.  Depending  on  whether  the  avian  bacillus 
represents  a  particular  variety  or  species,  and  is  or  is  not  capable  of 
developing  in  mammals,  tuberculous  birds  ^must  be  considered  dan- 
gerous or  innocent  for  man.  If  the  avian  bacillus  has  no  relation  to 
that  of  mammals  affected  birds  can  be  safely  utilised  for  food,  or  kept 
in  close  proximity  to  man  without  danger. 

It  is  impossible  to  deny  that  important  differences  exist  between  the 
tuberculosis  of  mammals  and  that  of  birds.  We  have  shown  that  the 
avian  bacillus,  though  very  virulent  for  the  rabbit,  seldom  produces  in 
the  guinea-pig  more  than  circumscribed  discrete  lesions,  with  a  marked 
tendency  to  undergo  fibrous  transformation.  Conversely  the  human 
bacillus  is  but  slightly  dangerous  to  the  Gallinaceae,  and  its  inoculation 
into  birds  is  seldom  followed  by  the  growth  of  tubercles. 

But  there  are  exceptions  to  these  rules :  in  the  guinea-pig  the  avian 
bacillus  sometimes  produces  visceral  lesions  of  an  extremely  marked 
character,  which  can  be  transmitted  in  series.  Moreover  the  Gallinaceas 
are  not  entirely  immune  :  of  eighty-six  fowls  inoculated  with  mamma- 
lian tuberculosis  nine  showed  positive  results,  i.  c.  a  proportion  of 
about  10  per  cent. 

Although    the   Gallinaceae    show  unquestionable    resistance,    other 


TUBERCULOSIS    OF    PARROTS — ITS    RELATION    TO    HUMAN    TUBERCULOSIS.    559 


2 
14 


birds — the  Psittaceae  (the  parrot  tribe), — very  readily  contract  human 
tuberculosis.  Observation  tends  to  support  this  view,  and  experiment 
has  established  it  beyond  question. 

The  merit  of  having  first  drawn  attention  to  the  frequency  of 
tuberculosis  in  parrots,  and  of  having  shown  that  the  disease  especially 
affects  the  skin,  mucous  membranes,  subcutaneous  and  submucous 
connective  tissues,  the  articulations  and  bones,  is  due  to  Frohner  and 
his  assistant  Eberlein.  Of  700  parrots  brought  for  examination  to  the 
Berlin  school  170  were  tuberculous,  i.  e.  a  proportion  of  25  per  cent. 
Eberlein  gave  a  summary  of  fifty-six  of  these  cases,  according  to  which 
the  principal  localisations  were  as  follows  : 

Eye  and  periocular  region        ....         14 
Commissure  of  the  beak  .         .         .         .         n 

Tongue  .... 
Larynx    .... 
Bones  and  articulations  . 
In   Eberlein's  observations  tuberculosis  affected  the  skin  and   its 
appendages  in  twenty-nine  cases,  /.  e.  a  proportion  of  50  per  cent. 

The  cases  which  we  have  recorded  number  twenty-seven,  and  may 
be  divided  as  follows  : 

Tuberculosis  of  the  skin 
Tuberculosis  of  the  mucous  mem- 
brane    ..... 
Simultaneous  tuberculosis  of  the 
skin  and  mucous  membrane  . 
On  more  closely  studying  the  localisation  of  these  lesions  we  see 
that  they  most  frequently  occur  about  the  head,  especially  the  sides  of 
the  face,   the  periorbital   region,  and  the   commissures  of  the   beak. 
Eberlein  considers  that  the  left  side  is  more  frequently  attacked  than 
the  right,   without,  however,  being  able  to  give  any  reason  for  this 
predominance.     Finally,  it  is  not  uncommon  to  find  several  massed  or 
distributed  cutaneous  centres  in  the  same  animal. 

Studied  according  to  their  localisation  an  analysis  of  the  lesions  in 
our  twenty-seven  cases  proves  very  similar  to  that  of  Eberlein  : 
Cheeks,  periorbital  region,  and  eye    .  .12  cases 


15  cases,  t.  e.  55  per  cent. 
6  cases,  i.  e.  22  per  cent. 
6  cases,  i.  e.  22  per  cent. 


Commissures  of  the  beak  . 
Tongue      ..... 

Palate 

Upper  limbs  and  wings 

Claws  ..... 

Cervical,  dorsal,  and  caudal  regions 


560  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

In  order  to  convey  a  better  idea  of  the  seat  and  appearance  of  the 
lesions  we  very  briefly  summarise  these  observations. 


I.  Tuberculous  Lesions  of  the  Skin  and  Appendages. 

Case  i.  A  green  parrot  bought  in  April,  1886.  In  December,  1894, 
a  little  greyish,  firm,  scaly  swelling  was  noted  on  the  right  side  of  the 
face.  It  gradually  extended  to  subjacent  parts,  becoming  more 
prominent. 

On  the  ist  January,  1895,  this  tumour  was  removed  by  a  veterinary 
surgeon.     A  fortnight  later  it  returned. 

On  the  19th  January  the  parrot  was  brought  here.  The  right  side 
of  the  face  showed  a  greyish,  conical,  scaly  vegetation,  slightly  incurved 
at  its  extremity.  Examination  of  a  scraping  from  the  inflamed  skin 
around  the  base  of  the  growth  revealed  numerous  bacilli. 

The  tumour  was  removed,  the  skin  curetted  and  touched  with  the 
thermo-cautery. 

The  parrot  was  brought  back  again  on  the  12th  February,  1895. 
The  horny  mass  had  again  grown,  and  another  swelling  was  in 
course  of  formation  above  the  former.  The  same  treatment  was 
repeated. 

On  the  2nd  March  both  growths  had  returned,  and  a  fresh  one 
had  appeared  between  the  skin  and  the  upper  mandible. 

Case  2.  A  parrot,  the  globe  of  whose  eye  was  almost  entirely 
covered  by  the  lower  eyelid,  which  formed  a  fungating  swelling  the  size 
of  a  haricot  bean  ;  the  central  portion  was  caseous,  and  contained 
bacilli. 

Case  3.  A  parrot  with  a  tuberculous  horny  growth  developed  on 
the  right  side  of  the  head  immediately  behind  the  buccal  commissure. 
Brought  back  again  a  month  later  it  showed  other  small  horny  growths 
close  to  the  first. 

Case  4.  A  parrot  showing  a  large  horny  growth  below  the  lower 
mandible ;  the  surface  of  implantation  occupied  half  the  depth  of  the 
head  ;  this  horn  was  pyramidal  in  shape  ;  the  anterior  side  measured 
one  and  a  half  inches  in  length  ;  it  was  hard,  fragile,  and  stony  in 
appearance.  Two  similar  growths  the  size  of  hemp-seeds  existed  in 
front  of  the  left  eye. 

Case  5.  A  four-year-old  parrot,  imported  from  Brazil  at  the  age  of 
three  months.  For  some  time  this  bird,  previously  very  talkative, 
had  appeared  dull  and  quiet.  A  horny  growth,  the  size  of  a  small 
hazel-nut,  existed  on  the  right  cheek,  behind  the  base  of  the 
mandible. 


TUBERCULOUS    LESIONS    OF    THE    SKIN    AND    APPENDAGES    IN    PARROTS.       56 1 

Case  6.  A  parrot  which  had  shown  marked  wasting  for  several 
months.  On  the  right  side  of  the  head  was  an  indurated  cutaneous 
patch  the  size  of  a  sixpence ;  at  the  lower  part  of  the  neck  was  a 
horny  growth  as  large  as  a  haricot  bean  ;  on  the  back  a  similar  but 
smaller  patch  ;  finally,  on  the  sacrum  a  fungous,  bleeding,  ulcerated 
spot.  Examination  of  these  various  lesions  revealed  the  existence  of 
numerous  bacilli. 

Case  7.  A  parrot  brought  to  hospital  on  the  4th  May,  1894.  It 
was  thin,  dull,  and  had  not  talked  for  several  weeks.  On  the  right 
side  of  the  head,  three  eighths  of  an  inch  from  the  base  of  the  beak, 
was  a  horny  growth,  conical  in  shape,  covering  a  surface  about  three 
eighths  of  an  inch  square.  A  similar  growth  existed  at  the  base  of 
the  neck.  In  the  lumbar  region  was  a  circular,  granulating,  bleeding 
wound  surrounded  by  a  zone,  from  which  the  feathers  had  fallen. 

Case  8.  A  five-year-old  parrot,  which  for  two  years  had  belonged 
to  the  woman  who  brought  it.  A  horny  growth  had  appeared  on  the 
left  wing,  and  somewhat  later  another  had  developed  on  the  head. 

Case  g.  A  five-year-old  parrot,  which  had  been  in  its  owner's 
possession  for  three  years,  and  had  been  ill  for  five  to  six  months.  The 
left  side  of  the  head  behind  the  e3'e  was  the  seat  of  a  C3'lindrical,  horny 
growth,  about  three  eighths  of  an  inch  in  length,  and  one  sixth  of 
an  inch  in  thickness. 

Case  10.  A  parrot  which  had  appeared  ill  for  the  previous  five  to 
six  months.  Had  been  in  its  owner's  possession  for  two  years.  On 
the  right  side  of  the  neck  were  two  horny  tuberculous  growths,  about 
three  eighths  of  an  inch  in  length.  In  the  subcutaneous  connective 
tissue,  covering  the  larynx,  were  two  growths  the  size  of  a  small  hazel- 
nut.    The  right  wing  showed  an  ulcerated  tuberculous  patch. 

Case  ii.  A  parrot  which  had  belonged  to  the  same  person  for  the 
previous  eighteen  months.  About  three  months  before  its  appearance 
here  a  growth  of  fibrous  consistence  which  granulated  freely,  and  the 
centre  of  which  was  occupied  by  caseous  material,  had  appeared  on 
the  carpal  region  of  the  left  wing. 

Case  12.  Parrot  ill  for  about  six  months.  Horn}-  growth  on  right 
wing  over  the  humero-radial  articulation. 

Case  13.  Parrot  affected  for  the  previous  two  months  with  an 
ulcerated  tuberculous  swelling  of  the  metatarsal  region. 

Case  14.  Parrot  affected  with  two  swellings  the  size  of  hazel-nuts 
on  the  lower  part  of  the  right  claw.  The  muscles  of  the  claw  were 
atrophied,  and  the  animal  could  not  use  the  limb. 

Case  15.  Parrot  showing  a  horny  tumour  of  conical  form  at  the 
base  of  the   tail.     This  growth,  which  had  only  been   discovered   ten 

N  N 


562  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

days  previously,  measured  three  eighths  of  an  inch  in  length.     It  had 
invaded  the  anus  and  caused  obstinate  constipation. 

2.  Tuberculous  Lesions  of  the  Skin  and  Mucous  Monbranes. 

Case  16.  Parrot   ill  for  the  previous  three  months.      Two  horny 
growths,  one  over  the  throat,  the  other  on  the  left  side  of  the  head. 
Several  small  yellowish  vegetations  on  the  buccal   mucous  membrane 
behind  the  commissure  and  on  the  palate. 

Case  17.  Parrot  showing  two  cutaneous  horns  on  the  back  opposite 
the  wings  ;  whitish  patches,  the  size  of  a  lentil,  at  the  base  of  the 
tongue  and  on  the  left  side  of  the  larynx. 

Case  18.  Parrot  ill  for  the  previous  two  years.  On  either  side  of 
the  head,  opposite  the  commissures,  were  small  horny  growths.  On  the 
palate  was  a  conical  horny  growth,  the  size  of  a  haricot  bean,  directed 
forwards.  The  end  extended  beyond  the  tongue.  The  base,  which 
was  about  three  eighths  of  an  inch  in  diameter,  was  attached  to  a  finely 
granulating  surface. 

Case  19.  Parrot  bought  eighteen  months  before.  Had  shown 
difficulty  in  swallowing  for  the  past  six  months  ;  was  emaciated.  Two 
small  tumours  existed,  one  above  the  upper  mandible,  the  other  behind 
the  left  commissure,  each  the  size  of  a  pea.  A  third  ulcerated  swelling 
was  seen  on  the  palate.  The  bird  died  on  the  15th  March,  1895.  No 
visceral  lesions. 

3.  Tuberculous  Lesions  of  the  Mucous  Membrane. 

Case  20.  Parrot  which  for  the  previous  two  months  had  shown 
several  small  greyish  swellings  on  the  commissures  of  the  beak  and 
on  the  tongue.  These  growths  had  gradually  increased  in  size,  become 
confluent,  and  ended  by  forming  two  flattened  tumours  of  considerable 
thickness,  the  outer  part  of  which  extended  as  far  as  the  branches  of 
the  lower  mandible.  The  lingual  patches  having  been  detached  with  a 
director  the  mucous  membrane  beneath  was  seen  to  be  red,  thickened, 
and  granulating.  Another  patch  of  similar  character,  but  smaller 
extent,  occupied  the  palate. 

Case  21.  A  parrot  which  had  been  ill  for  five  months;  swallo\v'ing 
very  difficult  ;  extreme  wasting  during  the  last  month  ;  tuberculous 
vegetation  on  the  tongue  and  hard  palate. 

Case.  22.  Parrot  affected  with  a  large  swelling  at  the  base  of  the 
tongue ;  great  difficulty  in  deglutition.  For  five  or  six  months  pre- 
viously the  animal  had  suffered  in  condition. 

Case  23.  Parrot  showing  a  rounded  tuberculous  growth  the  size  of 
a  pea  on  the  hard  palate. 


TUBERCULOUS    VISCERAL    LESIONS    IN    PARROTS. 


563 


Case  24.  Parrot  suffering  from  tuberculous  patches  on  the 
tongue. 

4.   Visceral  Lesions. 

Case  25.  Parrot  which  had  been  ill  for  the  previous  eight  months. 
Tuberculous  hardened  growth  on  the  right  side  of  the  head  ;  tuber- 
culous swelling  on  the  left  wing  ;  hardened  growth,  about  three  quarters 
of  an  inch  in  length,  on  the  extremity  of  the  rump.  Feet  deformed 
and  contorted  ;  the  bird  had  difficulty  in  holding  on  its  perch.  It  died 
a  month  later. 

Autopsy. — -The  liver  and  spleen  were  crammed  with  tuberculous 
granulations  ;  both  legs  showed  deep-seated  lesions  of  the  bones,  articu- 
lations, periosseous  and  periarticular  tissues. 

Case  26  (Autopsy).  Tuberculosis  of  the  tongue,  larynx,  lungs,  and 
liver.  The  lesions  were  similar  to  those  usually  noted  in  the  Gallinacese. 
Two  tuberculous  spots  in  the  muscles  of  the  thigh  and  leg  ;  tuberculosis 
of  the  tarsal  joints  ;  some  cutaneous  tubercles. 

Case  27  (Autopsy).  Tuberculosis  of  the  tongue  and  nasal  cavities, 
lungs  and  liver  ;  a  tuberculous  spot  in  the  muscles  of  the  left  foot. 

The  above  cases   show   that   the   lesions  are   almost   always   of  so 


Fig.  78.  — Horny  growth  developed  on  a  tuberculous  patch  on 
the  cheek  (Eberlein-Krampf). 


special  a  character  as  to  have  rendered  it  impossible  to  detect  their 
nature  before  the  introduction  of  bacteriological  methods.  These 
cutaneous  manifestations  differ  entirely  from  the  lesions  seen  in  other 
animals,  and  can  only  be  compared  to  certain  forms  of  verrucous  lupus. 
In  general  the  first  sign  is  furnished  by  the  falling  of  the  feathers. 
The  skin  then  becomes  thickened  and  verrucous,  after  which  the 
growths  develop   and  are  covered  with  thick  crusts.     These  hardened 


564 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


growths  may  even  attain  two  inches  in  length,  and  three  eighths  to  three 
quarters  of  an  inch  in  width  at  their  base  (Fig.  78).  When  detached 
they  are  seen  to  have  grown  from  a  granular  or  fungous  tissue. 
Ulceration  is  not  uncommon,  and  occurs  most  readil}' when  the  diseased 
part  has  been  exposed  to  injur}',  or  to  repeated  rubbing. 

In  some  cases  the  lesion  occupies  the  subcutaneous  tissue.  It  then 
forms  a  growth  of  fibrous  consistence,  sometimes  as  large  as  a  cherry. 
At  a  later  period  the  centre  undergoes  softening  and  is  transformed 
into  a  caseous  magma. 

Finally,  peculiar  local  growths  are  sometimes  seen,  which  have 
caused  mistaken  diagnosis;  the  tubercles  develop  in  certain  parts  of 


Fig.  79. 


the  feet,  which  become  deformed  and  contorted,  precisely  as  in  the 
cases  described  under  the  title  of  "  gout  in  birds." 

The  external  lesions  may,  by  their  size  and  position,  cause  varying 
functional  disturbance.  They  may  cover,  or  close  the  eyes  (Fig.  79)  ; 
interfere  with  the  movement  of  the  mandibles,  and  when  in  the  anal 
region  render  defsecation  difficult  ;  while  those  on  the  feet  are  usually 
accompanied  by  muscular  atrophy,  and  sometimes  by  paresis. 

Vegetations  resembling  the  skin  lesions  may  be  seen  on  the  buccal 
mucous  membranes  ;  sometimes  they  are  simply  hard,  white  or  yellow- 
ish, slightly  prominent  patches  ;  in  others  conical  or  rounded  tubercles, 
varying  in  size   between  a  pea  and  haricot  bean,  considerablv  dimin- 


TUBERCULOUS    VISCERAL    LESIONS    IN    PARROTS.  565 

ishing  the  buccal  cavity  and  interfering  with  deglutition.  Despite 
their  development  from  a  mucous  membrane,  they  present  a  horny 
appearance ;  in  only  one  case  have  we  seen  an  ulcerated  growth  on  the 
palate.  Visceral  growths  may  develop  simultaneously  with,  or  apart 
from,  cutaneous,  articular,  or  buccal  lesions.  Some  may  be  detected 
by  the  symptoms  shown  during  life ;  gastro-enteritis,  for  instance, 
produces  diarrhoea  and  sometimes  passage  of  blood  ;  and  pulmonary 
tuberculosis  (which  Eberlein  regards  as  the  commonest  visceral  locali- 
sation) causes  continual  attacks  of  coughing. 

In  most  cases  development  is  extremely  slow.  The  onset  being 
insidious,  the  disease  is  often  overlooked  ;  and  the  large  growths  seen 
on  examination  have  often  been  described  as  the  product  of  a  week  or 
so. 

When  it  causes  no  functional  disturbance,  and  is  unaccompanied 
hy  visceral  lesions,  tuberculosis  produces  little  disturbance ;  birds 
may,  therefore,  continue  for  a  long  period  to  incubate  and  distribute 
the  bacillus  of  tuberculosis. 

Sooner  or  later,  however,  they  become  ill,  appear  dull  and  thin,  cease 
to  talk,  and  usually  die,  extremely  emaciated,  in  six  months  to  a  year. 
Sometimes,  however,  they  survive  for  a  much  longer  period.  We  have 
seen  parrots,  still  in  very  fair  condition,  two  years  after  the  onset  of 
disease. 

In  spite  of  their  slow  development,  the  cutaneous  lesions  are  diffi- 
cult to  cure.  In  Eberlein's  and  in  our  own  experience,  extirpation 
always  failed,  the  growth  recurring  in  a  few  weeks. 

It  is  difficult  to  exactly  estimate  the  frequency  of  visceral  lesions. 
Eberlein,  who  made  fifteen  post-mortem  examinations,  gives  the  follow- 
ing results  : 

No  visceral  lesions     . 
Tuberculosis  of  the  lungs 

,,  of  the  liver  . 

,,  of  the  intestine 

,,  of  the  muscles 

,,  of  bones  and  articulations 

,,  of  the  heart 

The  same  author  has  several  times  detected  tubercle  bacilli  in  the 
liver,  even  when  there  were  no  visible  granulations.  He  justly  lays 
stress  on  the  frequency  of  pulmonary  lesions,  which,  on  the  other 
hand,  are  very  rare  in  the  Gallinaceae. 

In  most  of  the  cases  we  have  seen  the  birds  were  kept  alive  by 
their  owners ;    in   only  seven  were  we  able  to  carry  out  post-mortem 


•     7 

cases 

•     4 

J5 

•     4 

)> 

•     3 

}  } 

.     I 

case. 

2 

cases 

.     I 

case. 

566 


CLINICAL    VKTERINARY    MEDICINE    AND    SURGERY. 


examinations.  In  three  of  these  (Cases  25,  26,  and  27)  we  found 
visceral  tuberculosis  in  the  form  of  little  miliary  granulations  scattered 
through  the  liver,  spleen,  and  lungs.  In  these  three  cases  we  also 
noted  tuberculous  points  in  the  bones,  articulations,  and  muscles. 

By  histological  examination  of  one  of  these  cases  we  discovered 
that  the  tubercles  in  the  liver  of  the  parrot  resemble  human  tubercles, 
and  differ  from  those  of  the  fowl  and  pheasant.  They  consist  of 
central  giant-cells,  round  or  fusiform,  peripheral  cells,  and  epithelioid 
intermediate  cells  (Fig.  80).  The  giant-cells  contained  a  very  large 
number  of  nuclei,  which  are  usually  distributed  throughout  the  cell,  or 
occupy  the  centre,  but  not  the  periphery,  thus  differing  in  appearance 
from  the  ordinary  giant-cell  in  human  tuberculosis.  In  these  centres, 
and  especially  in  their  giant-cells,  bacilli  appear  very  numerous. 

What  is  the  origin  of  tuberculosis  in   parrots  ?     This  is    the  most 


,^-«'^.-r^--=i%\5t<_ 


K 


mf:m 


^.  -'  •^. 


I'"lG    Llo. 


interesting  question  both  from   the   theoretical  and   practical  point  of 


view, 


One  can  hardly  believe  that  in  the  majority  of  cases  parrots  have 
been  inoculated  by  Gallinaceae.  Living  with  man,  they  never,  or 
scarcely  ever,  leave  the  house,  and,  as  a  rule,  have  no  opportunity  of 
coming  in  contact  with  poultry.  It  is,  therefore,  impossible  to  imagine 
how  they  could  contract  avian  tuberculosis. 

These  theoretical  considerations  are  supported  by  the  results  of  an 
inquiry  made  by  us  regarding  our  twenty-seven  cases.  In  seven  in- 
stances the  affected  parrots  belonged  to  persons  in  bad  health,  who 
appeared  thin  and  had  for  a  considerable  time   suffered  from  chronic 


ORUilN    OF    TUBERCULOSIS    IN    PARROTS.  567 

cough;  that  several  were  unquestionably  tuberculous  was  proved  by 
bacteriological  examination  of  their  sputa. 

Case  I,  described  in  the  foregoing  pages,  is  in  this  respect  absolutely 
conclusive.  The  parrot  had  lived  in  the  same  house  for  eight  years, 
and  had  always  enjoyed  good  health  ;  in  April,  1894,  its  owner  began 
to  cough  ;  in  December  the  bird  showed  tuberculous  patches  on  the 
sides  of  the  face.  At  this  time  microscopic  examination  revealed  the 
presence  of  tubercle  bacilli  in  the  cutaneous  growth  on  the  head  of  the 
parrot,  and  in  the  expectorations  of  its  owner.  The  owner  told  us 
that  he  was  in  the  habit  of  fondling  the  bird  ;  that  he  often  kissed  it 
on  the  head  and  sides  of  the  face  ;  and  that  he  made  it  take  from  his 
mouth  food  which  he  himself  had  masticated.  He  added  that  this 
parrot  was  the  only  animal  in  his  rooms  ;  that  it  had  never  come  in 
contact,  even  for  a  short  time,  with  other  birds,  and  that  it  lived  on 
seeds,  coffee  and  milk,  boiled  milk,  and,  finally,  food  which  he  himself 
had  chewed.  Is  not  this  case  as  complete  and  as  instructive  as  a 
laboratory  experiment  ?  How  is  it  possible  to  deny  that  this  bird, 
which  showed  cutaneous  tuberculosis  four  months  after  its  owner  had 
developed  the  first  symptoms  of  pulmonary  tuberculosis,  from  which 
he  died  a  year  later,  had  been  infected  by  the  owner  himself.-' 

In  Case  2  the  human  origin  of  the  disease  is  scarcely  less  clear.  A 
man  who  had  suffered  with  pulmonary  tuberculosis  from  1887,  and 
who  died  of  the  disease  in  January,  1895,  bought  in  1890  a  very  fine 
parrot,  which  showed  no  cutaneous  lesions.  At  the  commencement  of 
1894  the  bird,  which  its  owner  was  in  the  habit  of  fondling,  and  which 
ate  from  his  mouth,  developed  a  greyish  nodule  on  the  lower  eyelid  of 
the  left  eye;  the  nodule  gradually  increased  in  size,  and  ended  by  m- 
vading  the  entire  e}'elid. 

In  Case  16  the  disease  may  have  been  caused  in  the  same  way. 
The  parrot  belonged  to  a  tuberculous  woman,  who  was  in  the  habit  of 
feeding  it  from  her  mouth.  Tuberculosis  developed  simultaneously  on 
the  buccal  mucous  membrane  and  on  the  skin. 

Cases  3,  17,  and  21  refer  to  birds  which  belonged  to  tuberculous 
persons  ;  and  the  parrot  in  Case  4  had  often  been  in  contact  with  a 
woman  who  afterwards  died  of  pulmonary  tuberculosis. 

We  were  scarcely  surprised  that  in  the  other  cases  our  inquiries 
threw  no  light  on  the  question  of  human  infection.  Parrots  may 
contaminate  one  another,  and  may  also  contract  tuberculosis  from  the 
dust  existing  in  rooms, — that  is  to  say,  from  bacilli  introduced  from  out 
of  doors. 

Infection  may  occur  by  three  different  paths.  Sometimes  the  bacilli 
penetrate    by   the    respiratory  tract.       Thus    pulmonary    tuberculosis. 


568 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


though  exceptional  in  GalHnacese,  is  fairly  frequent  in  parrots  ;  this 
constitutes  a  further  analogy  with  human  tuberculosis.  Sometimes, 
however,  infection  occurs  through  the  skin  ;  sometimes  through  the 
digestive  tract.  But  while  the  Gallinaceas  are  almost  always  infected 
by  means  of  the  food,  and  frequently  show  tuberculous  enteritis, 
parrots,  although  they  sometimes  swallow  food  soiled  with  bacilli,  are 
most  commonly  inoculated  by  contact  with  tuberculous  persons,  or  by 
rubbing  the  head  against'  the  bars  of  their  cage.  This  explains  the 
frequency  in  them  of  lesions  about  the  head,  beak,  tongue,  palate,  or 
pharynx. 

Although  the  cases  we  have  recorded  appear  to  suggest  that  tuber- 


FiG.  8i. 


culosis  in  the  parrot  is  of  human  origin,  the  question  could  only  be 
finally  decided  by  experiment,  and  by  directly  transmitting  mammalian 
tuberculosis  to  birds.  We  made  three  attempts  of  this  character. 
The  results  were  so  clear  and  concordant  that  it  appeared  unnecessary 
to  multiply  experiments. 

Experiment  i.  On  the  20th  June,  1894,  ^  green  parrot  was  inocu- 
lated on  the  head  with  tuberculous  material  obtained  from  a  guinea- 
pig,  which  had  died  from  tuberculosis  of  canine  origin. 

On  the  5th  July  two  small  nodules  appeared,  and  became  covered 
with  thick  blackish  crusts.  On  the  15th  August  the  crusts  fell,  leaving 
exposed  a  roughened,  irritable,  verrucous  surface.     Most  of  the  nodules 


EXPERIMENTAL    PRODUCTION    OF    TUBERCULOSIS    IN    PARROTS. 


569 


showed  a  kind  of  horny  covering,  which  could  easily  be  removed. 
Microscopic  examination  of  a  fragment  of  morbid  tissue  revealed 
numerous  bacilli.  By  the  ist  October  the  lesion  had  extended  to  the 
root  of  the  beak  and  upper  part  of  the  neck.  On  either  side  it  over- 
lapped the  eyes,  which  were  covered  by  the  vegetations  developed 
around  them  (Fig.  81). 

The  loss  of  condition  and  increasing  dyspncea  caused  us  to  suspect 
visceral  extension  of  the  disease.  Unfortunately  during  the  night  be- 
tween the  2oth  and  21st  October  this  bird  was  partly  eaten  by  rats,  so 
that  no  complete  autopsy  could  be  made.  The  results  obtained,  how- 
ever, sufficiently  showed  that  mammalian  tuberculosis  may  in  the 
parrot  produce  cutaneous  lesions  identical  with  those  which  occur 
spontaneously. 

Experiment  2.  On  the  loth  Aucrnst,   1894,  a  green  parrot  was  ino- 


FlG.  82. 


■culated  like  the  preceding,  and  in  October  and  November  was  similarly 
re-inoculated.  In  December  the  feathers  were  shed  from  around  the 
point  of  inoculation,  and  the  skin  became  thickened  and  wrinkled; 
gradually  the  lesions  extended  to  the  neck,  beak,  and  claws ;  around 
the  mandibles  a  kind  of  sheath  developed,  particularly  marked  towards 
the  upper  parts.  The  vegetations  on  the  eyelids  almost  entirely 
covered  the  eyes  (Fig.  82).  The  parrot  ditd  on  the  28th  September, 
i8g6.  On  post-niurtcin  examination  no  visceral  lesions  were  discovered. 
Experiment  3.  On  the  17th  March,  1895,  a  parrot  was  inoculated 


57° 


CLINICAL,    VETERINARY    MEDICINE    AND    SURGERY. 


on  the  crown  of  the  head  with  canine  tuberculosis.  At  the  commence- 
ment of  June  the  skin  over  this  part  became  thickened  and  covered 
with  crusts.  The  lesions  continued  to  grow  and  vegetations  developed, 
one  of  which  was  specially  notable  on  account  of  its  size  and  horny 
covering  (Fig.  83). 

The  parrot  died  on  the  13th  September,  1895,  having  survived  ino- 
culation 179  days.  On  post-mortem  examination  no  visceral  growth  was 
discovered,  but  the  tuberculous  lesion  developed  at  the  point  of  inocu- 
lation was  seen  to  have  invaded  and  perforated  the  subjacent  bones  of 


Fig.  83. 


the    cranium.     On    microscopical    examination    tubercle    bacilli    were 
identified  in  the  new  growth. 

Mammalian  tuberculosis  inoculated  into  parrots  had  therefore  pro- 
duced lesions  similar  to  those  of  spontaneous  tuberculosis.  The  birds 
lost  condition,  and  died  emaciated  in  from  four  to  thirteen  months. 
On  post-mortem  examination  the  viscera  appeared  healthy,  and  con- 
tained no  bacilli  ;  the  organisms  had  remained  confined  to  the  point  of 
inoculation.  Sections  showed  large  numbers  in  the  local  lesions.  A 
single  inoculation,  however,  does  not  always  produce  tuberculous 
lesions.  In  some  cases  the  virus  must  be  introduced  several  times,  a 
fact  which  explains  how  certain  parrots  only  become  contaminated 
after  months,  or  even  years,  passed  in  the  neighbourhood  of  tuber- 
culous persons. 


EXPERIMENTAL    PRODUCTION    OF    TUBERCULOSIS    IN    PARROTS. 


571 


Having  shown  that  tuberculosis  of  parrots  is,  or  at  least  may  be, 
of  human  origin,  the  question  arises  whether  the  bacillus  maintains  its 
virulence  in  the  organism  of  these  birds.  We  have  endeavoured  to 
answer  this  question  by  directly  inoculating  with  bacilli  obtained  from 
several  parrots.  We  took  care  not  to  grow  the  virus  on  artificial  media, 
for  culture  notably  modifies  its  pathogenic  properties  ;  we  wished  to 
determine  the  virulence  of  the  original  bacilli. 

The  two  following  tables  summarise  two  series  of  inoculations,  the 
first  of  which  was  started  with  caseous  material  contained  in  the 
centre  of  a  tuberculous  swelling  of  the  wing  (Case  11),  the  second 
with  a  horny  growth  occupying  the  right  side  of  the  face  (Case  5). 


EXPERIMENT    IV. 


P.\KROT. 

Titberculoiis  growth  on  the  wing. 
April  nth*  1894. 


GUINE.\-PIG. 

Died  May  26th  (45  days). 
Tubercle   at  point  of  inoculation  ;   tubercu- 
losis of  the  peritoneum  and  liver. 


Guinea-pig.  R.^bbit. 

Died  June   i8th  (23    Killed  Novem- 


days). 

Tuberculosis  of  the 

peritoneum,  liver, 

and  spleen. 

I 

Guinea-pig. 

Died    October     15th 

(99  days). 
Generalised  tubercu- 
losis, spleen,  liver, 
and  lungs. 


ber  7th  (162 
days). 
A  few  gramda- 
tions  on  the  peri- 
toneum and  in 
the  liver. 


Guinea-pig. 
Died  May  29th  (48  days). 
Tubercle  at  point  of   inoculation ;  general- 
ised tuberculosis*  {peritoneutn,  liver, 
spleen,  and  lungs). 


Guinea-pig.  Guine.a-pig.  Rabbit. 

Died  September     Died  October        Killed  September 
29th  (123  days).    26th  (144  days).       23rd  (117  days). 
Generalised  tu-      Generalised  tu-     A  few  granulations 
berculosis.  bercitlosis.  on  the  peritoneum 

and  in  the  liver. 


*  We  have  rarely  witnessed  such  a  development  of  tubercles  ;  the  peritoneum  was 
covered  with  granulations,  the  spleen  enlarged  tenfold,  and  the  liver  was  crammed  with 
nodules.  The  lungs  contained  innumerable  large  tubercles,  particularly  in  the  posterior 
lobes.  The  mediastinal  and  mesenteric  lymphatic  glands  were  enlarged  and  caseous. 
Microscopic  examination  showed  all  the  affected  organs  and  tissues  to  contain  numerouii 
bacilli. 


572  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 

EXPERIMENT  V. 
Parrot. 

Horny  tuberctdoiis  growth  on  the  right  cheek. 
July  5th,  1894. 

Guinea-pig. 

Died  September  7th  (64  days). 

Generalised  tuberculosis  {peritoneum,  liver,  spleen,  kidneys,  and  lungs). 

I 

Guinea-pig. 

Died  October  15th  (38  days). 

Generalised  tuberculosis  {liver,  spleen,  and  lungs). 

I 

Guinea-pig. 

Died  September  27th  (43  days). 

Generalised  tuberculosis  {peritoneum,  liver,  spleen,  and  lungs). 


i  III 

Rabbit.  Rabbit.                          Fowl.                         Fowl. 

Died  September    ist,   1895  Killed  November  2ist      Killed  November    Killed  March  5th 

(278  days).  (357  days).                   nth,  1895  (349              (454  days). 

For  seventeen  days  prior  to  A  few  fibrous  tubercles                days).                       No  lesion, 

death    shelved  paraplegia,  on  the  peritormum  and            No  lesion. 

Generalised       tubercidosis  the  liver. 
{liver,      spleen,       kidneys, 
lungs,  dorso-lumbar  para- 
lysis of  cord). 


Experiment  6.  Guinea-pig  inoculated  on  the  gth  July,  1894,  with 
part  of  a  horny  cutaneous  growth  from  the  right  side  of  the  head 
(Case  6).  The  guinea-pig  died  on  the  30th  August,  i.  e.  at  the  end  of 
fifty-seven  days.  Autopsy  showed  numerous  granulations  on  the  peri- 
toneum, in  the  liver,  spleen,  and  lungs. 

Experiment  7.  On  the  28th  September,  1895,  three  fowls  were 
intra-peritoneally  inoculated  with  experimental  tuberculosis  of  the 
parrot  (Experiment  2).  One  was  killed  on  the  24th  November  follow- 
ing ;  another  on  the  5th  December ;  the  third  on  the  5th  March,  1896. 
No  change  whatever  was  found  on  post-mortem  examination. 

To  sum  up,  ten  guinea-pigs  inoculated  with  tuberculous  material 
obtained  directly  from  the  parrot,  or  having  passed  through  other 
guinea-pigs,  died  after  periods  varying  between  23  and  144  days,  that 
is  after  an  average  period  of  sixty-seven  days.  In  all,  post-mortem 
examination  showed  intense  and  generalised  lesions. 

Of  four  rabbits  inoculated  under  the  same  conditions  only  one  died 
spontaneously  at  the  end  of  378  days.  The  others  were  killed  between 
the  117th  and  the  359th  day.  In  spite  of  this  much  longer  survival, 
which  rendered  the  average  period  226  days,  we  only  found  on  post- 
mortem examination  a  few  discrete  granulations  on  the  peritoneum  and 
in  the  liver. 


RELATIONS    OF    MAMMALIAN    AND    AVIAN    TUBERCULOSIS.  573 

Tuberculosis  of  the  Psittaceae,  unlike  that  of  the  Gallinacege,  is 
therefore  much  more  virulent  for  the  guinea-pig  than  for  the  rabbit. 
In  this  respect  it  more  closely  resembles  tuberculosis  of  mammals, 
with  which  it  also  agrees  in  being  comparatively  harmless  for  the 
Gallinacese  (Experiments  5  and  7). 

Bearing  in  mind  the  results  already  obtained,  we  have  now  to  con- 
sider the  relations  existing  between  the  tuberculosis  of  mammals  and 
that  of  birds. 

Avian  tuberculosis,  which  is  ver}^  frequent  in  the  Gallinaceae,  can  be 
transmitted  to  the  fowl,  pigeon,  and  the  rabbit,  and,  with  less  facility, 
to  the  guinea-pig.  It  may  also  occur,  with  its  own  special  characters, 
in  the  ox  and  in  man  (Kruse's  and  Pansini's  cases). 

Mammalian  tuberculosis  affects  man,  the  dog,  ox,  and  horse,  and 
is  readil}-  conveyed  to  the  guinea-pig  and  rabbit,  which,  however,  is 
perhaps  less  sensitive  to  it  than  to  avian  tuberculosis  :  it  can  also  be 
inoculated  into  the  parrot,  and  sometimes  the  fowl. 

The  two  viruses,  therefore,  affect  the  same  animals.  The  titles 
given  them  are,  therefore,  not  precisely  correct,  for  the  so-called  tuber- 
culosis of  mammals  is  identical  with  that  very  commonly  seen  in 
parrots. 

These  results,  therefore,  render  the  barrier  which  was  erected 
between  the  two  viruses  very  narrow.  Though  it  is  allowable  and 
necessar}'  to  admit  the  existence  of  two  races  of  tubercle  bacilli,  it 
seems  to  us  exaggeration  to  speak  of  two  species.  Between  the 
extreme  t\pes  numerous  transition  forms  exist,  and  one  variety  can 
sometimes  be  transformed  into  the  other.  We  have  shown,  for 
example,  that  the  avian  virus,  after  several  passages  through  mam- 
mals, may  lose  its  virulence  for  the  Gallinaceas  ;  and  conversely  that 
human  tuberculosis,  when  by  chance  conveyed  to  a  fowl,  may  sometimes 
be  afterwards  passed  through  a  series  of  fowls.  But  to  obtain  such 
positive  results  it  is  necessary  to  multiply  experiments,  and  not  to 
rest  content  with  a  few.  For  this  reason  we  inoculated  eighty-six 
fowls  with  human,  and  fort}-two  guinea-pigs  with  avian  virus.  It  will 
be  conceded  that  so  large  a  number  of  experiments  gives  a  certain 
weight  to  our  conclusions. 

To  sum  up,  we  have  no  intention  of  attempting  to  establish  a 
complete  parallel  between  the  tuberculosis  of  Gallinaceae  and  that  of 
mammals.  They  show  notable  differences  which  we  were  not  the  last 
to  recognise,  but  we  continue  to  believe  that,  however  important  their 
distincti\-e  characteristic?  ma}'  be,  the\'  are  insufficient  to  destroy  the 
unicist  theor\-  of  tuberculosis. 


574  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

This  view  of  the  question  has  important  practical  consequences. 
In  parrots,  for  instance,  the  bacilH  acquire  extraordinary  virulence  for 
certain  mammals,  as  shown  by  our  inoculation  of  guinfea-pigs  ;  very 
rarely  is  human  tuberculosis  so  active  in  these  little  rodents.  Now 
bacilli  exist  in  large  numbers  in  the  cutaneous  growths,  the  buccal 
secretions,  the  nasal  discharge,  and  sometimes  in  the  excrement  ;  they 
may  readily  be  disseminated,  and  are  much  more  dangerous  when 
mixed  with  particles  of  organic  matter.  Parrots  inoculated  by 
man,  therefore,  become  in  turn  permanent  centres  of  tuberculous 
infection. 


III.— EXPERIMENTAL   TUBERCULOSIS    IN   THE    GOAT. 
By  MM.  Cadiot,  Gilbert,  and  Roger. 

Not  all  mammals  are  equally  prone  to  contract  tuberculosis,  and 
it  has  been  suggested  that  the  goat  and  dog  are  almost  completely 
refractory.  Cases  and  experiments  published  during  the  last  few  years 
have,  however,  shown,  contrary  to  formerly  held  opinion,  that  the  dog 
has  no  particular  immunity,  and  we  believe  the  same  is  true  of  the 
goat. 

Cases  of  spontaneous  tuberculosis — that  is  to  say,  tuberculosis 
occurring  apart  from  experimental  inoculation — are,  it  is  true,  rare, 
but  this  is  partly  due  to  the  small  number  of  goats  which  are  kept, 
to  the  little  attention  which  has  as  yet  been  given  to  their  diseases, 
and  to  the  conditions  under  which  they  live.  We  know,  in  point  of 
fact,  that  goats  usually  live  in  the  open  air  :  in  poor  countries  they 
seldom  leave  the  hills  ;  under  other  circumstances  they  are  kept  in 
special  sheds,  and  are  therefore  little  exposed  to  contagion.  Now 
the  majority  of  reported  cases  refer  to  animals  which  lived  in  stables 
with  cows  or  horses. 

In  1 871  Carsten  Harms  published  the  history  of  a  goat  which  had 
been  ill  for  six  months,  and  on  the  post-uioiiciii  examination  of  which 
he  found  tubercles  and  cavernous  spaces  in  the  lungs.  Gerlach 
published  a  similar  case.     Lydtin  and  Motz  reported  five  others. 

In  a  case  mentioned  by  Sluys,  Korevaar,  and  Thomassen,  infection 
appeared  due  to  the  use  of  milk  from  a  tuberculous  cow;  the  lesions 
seen  on  autopsy  were  extremely  extensive  ;  they  affected  the  intestine, 
mesenteric  glands,  liver,  spleen,  kidneys,  and  lungs.  We  may  also 
refer  to  Konig's  case,  where  the  mesenteric  glands,  liver,  and  lungs 
were  affected,  and  d' Alston's,  in  which  tul^ercles  were  discovered  in 
the  lungs  and  bronchial  glands. 

This  problem  has  been  taken  up  by  experimental  pathologists,  and 
a  certain  number  of  instructive  cases  related.  The  goat  proves  to  be 
no    more    refractory    to    infection   by  the    digestive    tract    than    other 


576  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

domestic  animals ;  Bollinger's  experiments  remove  all  doubt  on  that 
point.  Wesemer,  who  summarised  all  experiments  made  between 
1865  and  1884  regarding  this  question,  found  that  in  the  goat,  as  in 
the  calf  and  sheep,  the  results  were  positive  in  about  50  per  cent,  of 
cases. 

Among  more  recent  work  may  be  cited  an  interesting  experi- 
ment by  M.  Nocard.  On  November  3rd,  1885,  a  goat  was  inoculated 
by  injecting  a  certain  quantity  of  tubercle  culture  into  the  jugular 
vein.  The  animal  was  killed  in  1890.  Its  lung  was  riddled  with 
cavernous  spaces,  and  caseous  or  encysted  nodules  in  which  bacterio- 
logical examination  revealed  tubercle  bacilli.  This  case  is  all  the 
more  remarkable  inasmuch  as  the  organism  used  was  probably  that 
of  avian  tuberculosis,  the  only  one  then  cultivated  in  France. 

M.  Nocard  supposed  that  tuberculosis  had  only  developed  because 
the  goat  employed  had  become  affected  with  mange,  which  had 
enfeebled  its  general  health  ;  and  he  states  that  as  a  rule  the  goat 
"  is  almost  absolutely  refractory  to  tuberculosis,  or  at  least  is  inocu- 
lated with  difficulty."  M.  Colin  again  took  up  the  question.  He 
subcutaneously  inoculated  a  goat  with  bovine  tuberculosis.  The 
animal  was  killed  at  the  end  of  two  months.  Characteristic  lesions 
were  found  at  the  point  of  inoculation,  in  the  lymphatic  glands  of  the 
corresponding  side,  and  in  the  lungs.  With  this  result  before  him 
M.  Colin  had  no  hesitation  in  declaring  that  the  goat  is  not  refrac- 
tory to  tuberculosis.  This  is  also  the  opinion  of  M.  Galtier,  who, 
whilst  freely  admitting  the  rarity  of  spontaneous  tuberculosis,  recognises 
that  the  disease  ma}'  be  experimentally  transmitted. 

Such  a  collection  of  facts  appears  convincing.  Undoubtedly  the 
objection  may  be  made  that  in  the  old  experiments  tuberculosis  was 
not  produced,  but  the  objection  is  not  of  much  value,  for  the  lesions 
noted  were  as  t3'pical  as  those  of  the  ox  :  and  in  more  recent  re- 
searches the  detection  of  the  tubercle  bacillus  entirely  removed  this 
objection. 

As  some  authors  continue  to  maintain  that  goats  are  refractory  to 
tuberculosis  we  may  here  briefly  give  the  results  of  three  fresh  experi- 
ments. 

On  the  28th  January,  1892,  two  goats  were  inoculated  by  intra- 
peritoneal injection  with  tuberculous  material  from  a  dog.  They  were 
killed  on  the  8th  May.  In  the  first  tubercles  were  found  on  the 
peritoneum,  in  the  mesenteric  glands,  lungs,  and  mediastinal  glands, 
and  some  granulations  in  the  liver  and  kidneys.  In  the  second 
tubercles  were  also  found  on  the  peritoneum,  and  in  the  lungs  and 
liver,  while  the  chest  contained  a  slight  amount  of  exudate. 


EXPERIMENTAL  TUBERCULOSIS  IN  THE  GOAT. 


577 


On  the  29th  July,  1892,  a  third  goat  was  subcutaneously  and  intra- 
peritoneally  inoculated  with  tuberculous  material  from  a  horse.  It 
remained  in  good  condition  until  October.  From  that  time  it  began 
.to  lose  condition,  and  in  spite  of  its  appetite  remaining  good,  wasting 


."^f^S 


/"y^'         N, 


Fig.  84. 

gradually  became  more  marked  until  death  occurred  on  the  6th  April, 
1893.     The  autopsy  revealed  somewhat  extensive  lesions. 

On  opening  the  abdominal  cavity  a  quantity  of  greyish  liquid, 
holding  in  suspension  fibrinous  flocculi,  escaped.  The  parietal  and 
visceral  peritoneum  was  covered  with  fine  granulations  and  tubercles, 
some  the  size  of  a  hazel  nut.  The  lesions  were  confluent  over  the 
entire  extent  of  the  epiploon,  and  in  the  portions  of  the  peritoneum 
covering  the  lower  wall  of  the  abdomen,  diaphragm,  and  rumen.     The 

o  o 


57^  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY 

loops  of  intestine  were  glued  together,  and  to  the  parietal  peritoneum 
by  numerous  adhesions.  The  liver,  spleen,  and  kidneys  were  infil- 
trated with  tubercles.  All  the  abdominal  lymphatic  glands  were 
affected.  The  thoracic  cavity  contained  half  a  pint  or  more  of  greyish 
serosity  mixed  with  fibrinous  flocculi.  The  pleura  was  completely 
covered  with  fine  granulations.  On  its  diaphragmatic  portion  were 
tubercles  varying  in  size  between  a  millet  seed  and  of  a  haricot  bean. 
Along  the  course  of  the  aorta  the  mediastinal  glands  formed  a 
voluminous,  fusiform,  greyish  mass  marked  with  numerous  little 
greyish-white  tubercles. 

The  surface  of  both  lungs — and  particularly  that  of  the  posterior 
lobes — showed  prominent  greyish  tuberculous  growths,  the  centres  of 
which  were  softened  ;  similar  growths  had  developed  in  the  depths  of 
the  lungs.  Even  the  heart  was  invaded,  the  myocardium  of  the  left 
ventricle  showing  a  large  tuberculous  growth  (Fig.  84). 

The  tubercle  from  the  heart  was  examined  histologically,  and  for 
tubercle  bacilli.  Almost  the  whole  of  this  tubercle  was  composed  of 
degenerating  cells.  Only  the  periphery  contained  masses  of  living 
cells.  In  places  the  growth  had  undergone  fibrous  change,  and  these 
contained  numerous  bacilli. 

The  cases  and  experiments  we  have  described  in  this  note  appear 
sufficiently  numerous  to  carry  conviction.  We  were,  therefore,  some- 
what surprised  to  see  in  a  recent  book  that  the  goat  is  refractory  to 
tuberculosis,  and  that  up  to  the  present  day  no  observations  have  been 
published  proving  the  occurrence  in  it  of  tuberculous  lesions.  The 
slightest  bibliographical  search  would  have  convinced  the  author  of  his 
error. 

But,  if  the  goat  possesses  no  immunity,  what  becomes  of  that 
method  of  treatment,  which  consists  in  transfusing  its  blood  into  the 
veins  of  phthisical  patients  ?  As  no  serious  experiments  appear  to 
justify  this  method  of  treatment  its  application  to  man  is  entirely 
unwarranted.  Luckily  the  suggestion  almost  immediately  fell  into 
well  deserved  oblivion. 


IV.— MALIGNANT  TUMOURS   IN   ANIMALS. 
By  MM.  Cadiot,  Gilbert,  and  Roger. 

Animals  frequently  suffer  from  tumours  similar  to  those  affecting 
man.  The  occurrence  of  such  lesions  was  recognised  by  the  oldest 
authors  who  devoted  their  attention  to  animal  pathology.  They  are 
mentioned  in  the  writings  of  the  Greeks  and  Latins,  and  in  the  works 
of  the  Hippiatres,  but  the  merit  of  having  first  given  exact  descriptions 
of  some  of  them,  and  of  having  shown  their  frequency  in  carnivora — 
especially  in  the  dog — must  be  ascribed  to  Huzard  in  the  eighteenth 
century. 

From  1825,  when  the  first  French  veterinary  medical  journals 
appeared,  the  question  was  studied  by  a  large  number  of  observers, 
among  whom  may  be  mentioned  Trousseau  and  U.  Leblanc,  Gerlach, 
C.  Leblanc,  Trasbot,  and  Plicque. 

At  the  present  day  we  know  that  cancer  may  occur  in  all  species  of 
animals.  The  fact  that  it  has  seldom  been  noted  in  the  goat  and 
sheep  is  undoubtedly  due  to  neglect  of  the  pathology  of  these  animals  ; 
what  is  true  of  tuberculosis  probably  applies  also  to  cancer ;  cases  will 
be  found  if  trouble  is  taken  to  look  for  them. 

Among  the  domestic  animals  the  dog  is  most  frequently  affected 
with  new  growths,  then  the  hor.se,  and  afterwards  the  cat,  ox,  and  pig. 
In  birds,  tumours  are  not  uncommon,  but  many  show  special  histo- 
logical characters. 

etiology  and  Pathogeny. — In  animals  the  aetiology  of  tumours  is  as 
obscure  as  in  man.  The  influence  of  heredity  seems  established  by 
several  cases.  We  saw  a  bitch  which  had  twice  been  operated  on  at 
intervals  of  a  year  for  cancer  of  the  mammary  gland.  Two  of  her 
progeny  were  also  attacked  with  mammary  cancer,  one  when  four 
years  old,  and  the  other  when  five,  that  is,  at  ages  when  epithelial  new 
growths  are  somewhat  rare. 

Age  plays  an  important  part  as  a  predisposing  cause.  Of  thirty- 
three  cases  in  the  dog,  in  which  the  age  was  exactly  known,  the  figures 
were  as  follows  : — one  case  at  three  years  ;  one  at  four  years  ;  two  at 
five  years ;  four  at  six  years  ;   nine  at  seven  to   eight  years  ;  eight  at 


S8o  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

nine  to  ten  years ;  five  at  eleven  to  twelve  years  ;  two  at  fourteen 
years ;  and  one  at  twenty  years.  In  the  horse  the  age  varies  between 
seven  and  fifteen  years.  The  nature  of  the  congenital  tumours 
described  by  some  authors  has  not  been  established  by  sufficiently 
exact  microscopic  examination  to  justify  us  in  admitting  their 
existence. 

Primary  cancers  generally  appear  on  the  surface  of  glandular 
organs,  or  in  external  parts  exposed  to  mechanical  irritation.  It  has 
been  suggested  that  in  the  horse  friction  of  the  harness  is  sufficient  to 
produce  cancer.  In  reality  these  growths  are  chronic  inflammatory 
indurations,  sometimes  exhibiting  the  appearance  of  fibromata,  or  are 
parasitic  lesions  due  to  the  presence  of  bothryomyces.  Mere 
mechanical  injury  is  not  sufficient  to  produce  the  growth  of  tumours; 
observation  tends  to  establish  this  point,  and  experiments  also  point  in 
the  same  direction.  We  mechanically  irritated  the  mammary  gland 
in  several  old  eczematous  bitches ;  every  day,  or  every  two  days  the 
glands  were  compressed  and  bruised  by  means  of  strong  w'ooden  for- 
ceps ;  although  the  experiments  were  continued  for  months,  we  never 
succeeded  in  producing  new  growths,  and  only  in  two  cases  did  an 
abscess  form. 

Mechanical  injury,  therefore,  only  plays  a  secondary  part.  The 
same  is  true  of  the  hygienic  conditions  under  which  animals  exist. 
Contrary  to  the  statements  of  some  authors,  we  believe  that  it  is 
impossible  to  render  animals  cancerous  by  submitting  them  to 
special  life  conditions.  But  it  seems,  according  to  Leblanc's  state- 
ment, that  animals  restricted  to  meat  diet  and  chained  or  shut  up 
are  more  often  affected  with  cancerous  lesions  than  others. 

Among  predisposing  causes  it  is  still  usual  to  mention  gout. 
M.  Trasbot  strongly  insists  on  the  part  played  by  this  diathesis. 
According  to  him,  dogs,  and  even  horses,  suffering  from  cancer  have 
almost  always  previously  shown  eczematous  eruptions. 

At  the  present  time  the  tendency  is  to  consider  cancer  as  a 
parasitic  affection,  and  cases  have  been  described  in  man  which 
appear  to  establish  this  contagious  character.  We  have  noted 
nothing  similar  in  animals.  All  the  attempts  we  have  made  to 
transmit  new  growths  from  man  to  the  dog,  from  dog  to  dog,  or  from 
the  dog  to  the  rabbit  or  fowl,  have  uniformly  failed  ;  nor  were  we 
more  successful  in  attempting  to  graft  fragments  of  their  own 
tumours  on  healthy  parts  of  cancerous  dogs.  On  two  occasions  we 
seemed  at  first  to  have  obtained  a  positive  result  ;  but  in  one  of 
these  cases  the  secondary  tumour  had  none  of  the  histological  cha- 
racters of  the  primary ;  and,  in  the  other,  the  lesions,  though  ofi'ering 


MALIGNANT    TUMOURS    IN    ANIMALS.  S'St 

the  macroscopic  appearances  of  cancer,  proved  in  reality  due  to  tuber- 
culosis. 

These  two  cases  led  us  to  doubt  the  old  records  and  those  in  which 
the  histological  or  bacteriological  characters  of  the  lesions  produced 
have  not  been  carefully  studied.  We  may  add,  however,  that  we 
succeeded  in  transmitting  to  dogs  papillomatous  vegetations  developed 
on  the  glans  penis  of  an  affected  dog.  The  growths  thus  produced, 
however,  remained  local  and  underwent  retrogressive  processes,  be- 
having in  fact  like  simple  grafts.  MM.  Duplay  and  Cazin  have 
related  a  similar  case. 

Negative  results  do  not  justify  us  in  denying  the  parasitic  nature  of 
cancer.  They  simply  suggest  the  need  for  modifying  our  experimental 
methods,  for  they  tend  to  show  that  we  shall  not  solve  the  problem  by 
merely  multiplying  inoculations  by  processes  hitherto  employed. 

Position  of  the  Tumours. — In  animals,  as  in  man,  cancer  may  attack 
the  most  varied  tissues,  but  shows  a  well  marked  predilection  for  the 
mammary  gland.  Of  thirty-eight  cases  observed  in  dogs  eighteen 
consisted  of  mammary  tumours,  a  fact  which  explains  the  greater 
frequency  of  cancer  in  the  bitch.  After  the  mammary  gland  the 
testicle  is  one  of  the  organs  most  frequently  attacked.  Retention  of 
this  gland  within  the  abdomen  seems  to  predispose  it  to  degenerative 
new  growths.  It  is  not  uncommon  to  find  cancerous  testicles  in 
monorchid  or  cryptorchid  horses. 

Malignant  tumours  also  occur  with  some  frequency  in  certain 
exposed  parts  and  on  certain  mucous  membranes.  The  nose  and 
sinuses  of  the  face  are  the  seat  of  various  new  growths.  The  same 
is  true  of  the  digestive  tract.  Cancer  of  the  tongue  is  exceptional ; 
that  of  the  lips,  though  rare  in  large  animals,  is  fairly  frequent  in 
old  dogs,  in  which,  however,  it  must  not  be  confused  with  a  special 
affection  which  has  long  been  regarded  as  of  epitheliomatous  nature. 
This  so-called  canchroid  of  the  lip  is  oftenest  noted  in  the  cat,  and 
has  also  been  seen  in  the  dog  ;  it  is  an  ulcerative  inoculable  lesion, 
but  it  heals  with  great  facility.  On  histological  examination  the  growth 
shows  no  resemblance  to  cancer. 

Cases  have  been  published  of  cancer  of  the  pharynx  (Benjamin)  ; 
of  .the  oesophagus  (Lorenz)  ;  of  the  stomach  in  the  horse  (Roloff, 
Mouquet,  and  Cadiot)  ;  of  the  pylorus  in  the  dog  (Miiller) ;  of  the 
rumen  (Siedamgrotzky)  ;  and  of  the  reticulum  in  the  cow  (Beylot) ;  of 
the  intestine  (numerous  observations)  ;  of  the  anus  (Trasbot).  Some- 
times the  abdominal  viscera  are  affected,  as  the  pancreas  (Nocard, 
Martin)  ;  liver  (Benjamin  and  Martin);  kidney  (Siedamgrotzky,  Johne, 


582  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

Harvey)  ;  bladder  (Martin  and  Stolz)  ;  prostate  (Cadiot)  ;  and  other 
parts  of  the  genital  apparatus.  We  have  already  mentioned  the 
frequency  of  new  growths  in  the  testicle.  Cases  have  also  been  seen 
of  cancer  of  the  penis,  of  the  sheath,  and  of  the  ovary  (Kriiger) ;  uterus 
(Giirlt,  Lucet),  and  vulva  (Martin).  Contrary  to  the  experience  of 
human  surgeons,  cancer  of  the  uterus  is,  in  animals,  extremely  rare. 

Among  the  other  organs  affected  we  may  mention  the  parotid 
(Laugeron  and  Cadiot)  ;  pituitary  gland  (Mollereau)  ;  thyroid  gland 
(Cadiot)  ;  the  lung  and  maxillaries  (Leisering,  Barrier,  Cadiot)  ;  neck 
(Miiller)  ;  tail  (Miiller,  McFadyean).  We  have  several  times  seen 
cancer  of  the  eye  in  the  horse  and  dog.  Mauri  saw  pulmonary 
cancer  with  secondary  growths,  in  the  ox. 

Visceral  cancers  are  much  rarer  than  was  formerly  believed.  In  a 
great  number  of  cases  the  growths  found  in  the  thoracic  or  abdominal 
viscera,  are  due  to  tuberculosis.  This  mistake  has  long  been  made  in 
connection  with  the  dog,  for  in  this  animal  tuberculosis  often  produces 
large  growths  which  invade  the  viscera,  especially  the  liver  and  lungs, 
or  the  serous  membranes,  particularly  the  peritoneum  and  pleura. 
The  mistake  may  not  be  discovered  even  on  histological  examina- 
tion, because  the  structure  of  the  growth  rather  recalls  sarcoma  or 
lymphadenoma  than  tubercle.  Only  the  detection  of  bacilli  and  the 
results  of  inoculation  reveal  the  true  nature  of  these  growths.  The 
same  remarks  apply  to  the  horse.  Many  cases  regarded  as  lymph- 
adenoma  or  visceral  tumours  are  really  due  to  tubercle. 

Growths  produced  by  vegetable  parasites  have  long  been  mistaken 
for  cancer,  and  especially  for  sarcoma.  Among  such  are  bovine 
actinomycosis  and  equine  bothryomycosis,  both  of  which,  however, 
are  well  known  and  readily  diagnosed  at  the  present  day. 

It  v/ould  almost  seem  that  acari  may  excite  the  development  of 
new  growths.  In  an  old  bitch  suffering  from  tumours  of  the  vulva, 
which  had  deformed  the  vagina  and  at  certain  points  had  perforated 
its  walls,  microscopic  examination  showed  the  new  growths  to  be 
formed  of  round  cells,  amidst  which  acari  were  discovered. 

To  sum  up,  animals  may  show  lesions  resembling  tumours,  which, 
however,  have  been  produced  by  the  most  varied  processes,  some 
tuberculous  in  character,  others  due  to  vegetable  parasites,  like  actino- 
mycoses and  bothryomycoses,  or  to  animal  parasites,  like  acari ;  others, 
again,  of  an  ulcerous  nature  resulting  from  the  action  of  microbes,  like 
canchroid  of  the  lip  in  the  cat. 

Most  of  the  older  writers  having  failed  to  sufficiently  guard  against 
these  causes  of  error,  it  is  difficult  to  draw  conclusions  from  their 
reports.     Confusion   has  occurred  even   in  recent  experiments,  a  fact 


MALIGNANT    TUMOURS    IN    ANIMALS. 


583 


which  explains  the  opinion  still  held  that  sarcoma  is  more  frequent 
than  carcinoma. 

Thus  Semmer,  after  examining  fifty-seven  malignant  tumours, 
which  he  had  collected,  found  thirty-two  sarcomatous  and  twenty-five 
carcinomatous.  In  a  special  report  he  related  fifty-six  new  cases  of 
sarcoma.  In  the  table  printed  below  we  have  compared  Semmer's 
figures  with  our  own.  It  will  be  noted  how  widely  our  results  differ 
from  his. 

According  to  our  researches,  chiefly  on  the  dog,  epithelioma  is 
much  commoner  than  sarcoma.  The  opposite  opinion  is  probably 
due  to  the  mistakes  so  often  made  between  sarcoma  and  tuberculosis.* 


Semmer's 

Statistics. 

Our  own  Statistics. 

Species  of 

'' 

"■ 

Tumours  of 

Animal. 

Carcinomata. 

Sarcomata. 

Epitheliomata 

Sarcomata 

doubtful 
character. 

Dog.     .     . 

7 

17 

30 

27 

II 

— 

Horse    .     . 

'4 

7 

12 

4 

I 

— 

Ox    .     .     . 

4 

2 

4 

— 

Pig    .     .     . 

— 

I 

2 

— 

Cat    .     .     . 

— 

^-. 

I 

— 

— 

Birds     .     . 

— 

4 

6 

— 

— 

3 

Fishes    .     . 

— 

I 

2 

~       !        ~ 

25 

32 

^(> 

32                      12                      3 

The  figures  showing  the  frequency  of  tumours  in  animals  treated 
at  the  Berlin,  Munich,  and  Dresden  schools,  for  an  average  period  of 
seven  years,  are  as  follows  : — 

Of  86,113  diseased  horses,  1113  suffered  from  tumours  =  i"3  per  cent. 
Of  85,537  diseased  dogs,  4020  ,,  ,,  ,,         =  47       >» 

Of  4972  diseased  oxen,  102  ,,  ,,  ,,         =2  ,, 

Frohner  determined  the  nature  of  643  tumours  removed  from  dogs 
in  the  chnique  for  small  animals  at  the  Berlin  school.  He  found  :  306 
malignant  tumours  {i,  e.  about  47  per  cent.)  ;  262  epitheliomata  (40  per 
cent.)  ;  and  44  sarcomata  (7  per  cent.).  Of  47  new  growths  removed 
from  the  horse,  16  were  malignant  (34  per  cent.)  ;  10  sarcomata  (21 
per  cent.)  ;  and  3  epitheliomata  (6  per  cent.).  Of  75  new  growths  from 
oxen,    the   histological    examination    of    which    was   carried   out   by 

*  In  his  Pathologie  der  Geschwiilste  bei  Thieren,  Caspar  has  collected  interesting  statistics 
regarding  tumours  in  animals  from  the  reports  made  by  the  professors  of  clinical  medicine 
and  pathological  anatomy  in  the  German  veterinary  schools. 


5^4  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

Eggeling  of  the  ambulatory  clinique  at  Berlin,  22  were  malignant 
(29  per  cent.)  ;  20  sarcomata  (27  per  cent.) ;  and  2  epitheliomata 
(27  per  cent.). 

A  pathological  report  by  Johne  comprises  a  description  of  all  the 
new  growths  seen  in  4439  animals  examined  after  death  at  the 
Dresden  school  during  a  period  of  sixteen  years  : — 

Of  1181  horses,  128  suffered  from  tumours  (11  per  cent.) ;  of  1600 
dogs,  93  suffered  from  tumours  (5-8  per  cent.)  ;  of  1658  oxen,  104 
suffered  from  tumours  (6"3  per  cent.).  Among  the  128  tumours  from 
the  horse  were  60  sarcomata  (47  per  cent.),  and  28  epitheliomata  (22 
per  cent.).  The  93  tumours  from  the  dog  furnished  48  epitheliomata 
(52  per  cent.),  and  26  sarcomata  (28  percent.).    The  104 tumours  from 


Fig.  85. — Epithelioma  of  the  mammary 
gland  (bitch).  The  centres  of  the  alveoli 
contain  a  hyaline  substance. 


Fig.  86.— Epithelioma  of  the  mammary: 
gland.  The  central  portions  of  the  alveoli 
are  occupied  by  degenerating  cells. 


the  OX  gave  36  sarcomata  (35  per  cent.),  and  8  epitheliomata  (8  per 
cent. 

The  differences  revealed  on  comparing  these  clinical  and  anatomo- 
pathological  statistics  are  explained  by  the  fact  that  the  lirst  referred 
almost  exclusively  to  external  tumours,  whilst  the  others  took  note  of 
the  total  number  of  new  growths  found  in  different  organs.  It  is  also 
well  to  remark  that  the  majority  of  these  statistics  were  collected  at  a 
time  when  the  lesions  of  actinomycosis,  bothryomycosis,  and  tuber- 
culosis were  included  under  the  title  "of  sarcomata. 

But  taken  as  a  whole  the  results  given  confirm  the  greater  frequency 
of  epithelial  tumours  in  the  dog  as  compared  with  the  horse  and  ox; 
and  they  again  show  that  in  the  herbivora  these  tumours  are  not  so 
exceptional  as  is  generally  suggested. 


Histological  Appearance. — All    authors    agree    in    recognising    the 


MALIGNANT    TUMOURS    IN    ANIMALS. 


585 


frequency  of  mammary  tumours.  We  have  studied  nineteen,  one  of 
which  was  obtained  from  a  mare  ;  the  others  being  of  canine  origin. 

The  tumour  from  the  mare,  and  eleven  of  the  tumours  removed 
from  bitches,  showed  the  histological  appearances  of  epitheliomata. 
They  were  composed  according  to  the  classical  schema  of  a  stroma 
surrounding  alveolar  cavities.  In  these  cavities  the  epitheliomatous 
cells  were  generally  arranged  around  the  margin,  producing  acini,  in 
the  centres  of  which  was  sometimes  found  a  clear  substance  exuded 
undoubtedly  by  the  newly  formed  cells  (Fig.  85)  ;  but  most  frequently 
(Fig.  86)  degenerating  cells  without  nuclei,  which  were  stained  a  dirty 
yellow  by  picrocarmine.  At  places  the  new  growth  deviated  from  the 
original  type  and  showed  irregularly  arranged  cells  contained  within 
alveolar  cavities,  or  grouped  together  in  large  masses.  In  some  cases 
the  stroma  predominated,  displacing  the  new  cells  and  producing  the 
appearance  of  scirrhous  cancer. 

Among  other  tumours  developed  in  the  mammary  glands  we  first 


Fig.  87.  —  Fusiform-celled  sarcoma  from  the  mammary  gland  of  the  bitch. 

mention  two  fusiform-celled  sarcomata  (Fig.  87).  The  cells  contained 
large  nuclei  provided  with  clearly  marked  nucleoli  ;  at  certain  points 
degenerating  cells  could  be  seen. 

In  three  cases  we  found  a  form  of  sarcoma  with  rounded  or  oval 
cells  massed  together  or  scattered  through  a  chondroid,  hyahne,  or 
fibrillated  substance,  showing  at  several  points  true  chondroplasts  pro- 
vided with  cartilaginous  cells  (Fig.  88). 

In  other  cases  the  development  of  the  growth  had  led  to  formation 
of  a  tissue  resembling  bone ;  of  this  we  saw  two  examples.  In  one 
the  tumour  was  formed  of  granular  blind  sacs  ahernating  with  hyahne 
cartilage  and  osteoid  growths  ;  osteoplasts  and  canaliculi  could  even 
be  detected,  though  the  latter  were  less  numerous  and  less  well  defined 
than  normal.    -  ' 


586 


CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 


The  other  case  was  that  of  an  aged  bitch,  in  which  the  new  growth 
had  existed  for  two  years  and  had  returned  after  partial  ablation. 
When  the  animal  was  killed  the  mammary  gland  and  lungs  were  found 
to  contain  tumours  of  cartilaginous  appearance,  ossified  in  places. 
Histological  examination  showed  that  the  tissue  resembled  the  spongy 
tissue  of  bone  and  contained  intercommunicating  areolae.  The  osseous 
portions  were  pierced  with  little  angular  cavities  filled  with  nucleated 
cells ;  they  differed  from  normal  bone  inasmuch  as  there  was  no 
lamellar  arrangement  and  no  Haversian  canals,  while  the  basement 
substance  stained  red  v.'ith  picrocarmine.     The  areolae  surrounded  by 


Fig.  88. — Chondroid  sarcoma  of  the  mammary  gland  (bitch.) 


this  osteoid  tissue  contained  cells  like  those  in  bone  marrow 
(Fig.  89). 

After  those  of  the  mammary  gland,  tumours  of  the  testicle  are 
amongst  the  most  frequent.  We  have  examined  five,  three  from  the 
dog  and  two  from  the  horse. 

In  the  horse  the  tumour  may  attain  considerable  size :  in  one  case 
it  weighed  four  and  a  half  lbs. ;  in  another  affecting  a  retained  testicle 
the  weight  was  6  lbs.  10  ozs. 

All  five  tumours  had  a  very  similar  appearance.  They  consisted 
of  a  stroma,  according  to  the  development  of  which  in  various  parts 
t*^^   new   growth    resembled    encephaloid   or   scirrhous  cancer.     The 


MALIGNANT    TUMOURS    IN    ANIMALS. 


587 


individual  characteristics  of  the  cells  and  general  arrangement  of  the 
cylinders  recalled  the  appearance  of  normal  testicle  tissue  (Fig.  90). 

In  animals  cancer  not  infrequently  appears  first  in  the  nasal  fossae, 
or  in  the  facial  sinuses.     Sometimes  it  originates  in  the  paradental 


Fig.  89.--Ostejid  sarcomn  of  th  -  mammary  gland  (bitch). 

epithelial  debris  and  invades  the  superior  maxilla.  We  have  collected 
three  cases  of  these  various  localisations  in  the  dog  and  two  in  the 
horse. 

One  of  the  dogs  exhibited  a  lymphadenoma  readily  recognisable  by 
its  reticulated  stroma  containing  small  round  cells  and  vessels  with 
normal  walls.  The  two  other  dogs  showed  alveolar  epitheliomata,  in 
which  the  stroma  was  scanty  and  the  cells  polyhedral  or  polymorphic. 

The  lesions  were  very  different  in  the  horses ;  one  horse  showed  a 


Fig.  90.  —  Epithelioma  of  the  testicle  (dogl. 

globo-cellular  sarcoma  ;  in  the  other  the  tumour  was  more  complex, 
being  formed  of  rounded  cells,  among  which  were  disposed  epithelio- 
matous  tracts. 


588 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


Cancer  may  attack  any  of  the  glands  of  the  digestive  tract.  In  the 
dog  we  have  seen  epithehoma  of  the  parotid  (Fig.  91)  remarkable  fpr 
the  presence  of  epidermal  nests.     This  appearance,  also  seen  in  man, 


Fig.  91.  — Epithelioma  of  the  parotid  (dog). 

is  explained  by  the  embryological  origin  of  the  parotid,  which  forms  a 
simple  outgrowth  of  the  buccal  mucous  membrane. 

One  of  the  most  curious  of  all  the  epithelial  tumours  was  seen  in  an 


Fig.  92.  —  Pavement  epithelioma  of  the  stomach  (mare). 

eleven-year-old  mare  which,  though  previously  in  good  health,  rapidly- 
succumbed  to  an  accidental  infection.     On  post-mortem  examination 


MALIGNANT    TUMOURS    IN    ANIMALS. 


589 


the  stomach  was  found  to  contain  an  enormous  cancer,  which  had 
remained  completely  latent.  The  new  growth  occupied  the  left  side 
of  the  stomach,  and  was  irregularly  triangular  in  form,  with  its  base 


Fig.  93. — Epithelioma  of  the  peri-anal  gland  (bitch). 

uppermost  ;  it  measured  ten  and  a  quarter  inches  in  length,  and  nine 
and  a  half  inches  in  breadth  ;  its  surface  was  ulcerated  and  covered 
with  reddish  mammillated  vegetations.  The  lesion,  which  had 
extended  three  eighths  of  an  inch  into  the  cesophagus,  stopped 
abruptly  at  the  Jine  of  separation  between  the  cuticular  and  villous 
portions  of  the  gastric  mucous  membrane,  altogether  avoiding  the 
latter.  At  its  margin  the  wall  of  the  stomach  was  thickened,  indu- 
rated, and  in  places  oedematous.  The  growth  occupied  that  portion 
of  the  gastric  mucous  membrane  which  in  the  horse  is  continuous 


Fig.  94. 


Sebaceous  epithelioma  (dog). 


with  the  cesophagus.  Microscopic  examination  showed,  as  a  know- 
ledge of  anatomy  would  lead  one  to  anticipate,  that  the  tumour  was  of 
the  pavement  epitheliomatous  type  (Fig.  92). 


59° 


CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 


We  also  examined  a  tumour  developed  in  the  anal  region  of  an 
eight-year-old  bitch.  This  tumour,  which  had  existed  for  a  year  and 
attained  the  size  of  a  hen's  egg,  was  composed  of  tracts  of  cells, 
divided,  subdivided,  and  separated  from  one  another  by  partitions  of 
fibrous  tissue.  The  cells  were  polyhedral  in  shape  and  formed  of  a 
mass  of  protoplasm  which  stained  yellow  with  picrocarmine,  surround- 
ing a  circular  or  oval  nucleus ;  none  showed  any  signs  of  degeneration 
(Fig*  93)'  The  analogies  between  this  new  growth  and  certain 
tumours  of  the  liver,  pancreas,  and  kidney  led  us  to  regard  it  as  of 
glandular  origin  ;  a  view  strengthened  by  histological  examination  of 
the  perianal  region  in  the  dog,  in  which  we  found  many  glands  pre- 


Fig.  95. — Fusiform-celled  sarcoma  of  the  vertebral  column  (dog). 

senting  a  striking    resemblance  in  structure  or  arrangement  to    the 
tumour  examined. 

We  have  studied  three  cases  of  cancer  of  the  skin.  In  one  the 
tumour  was  in  the  anal  region  and  consisted  of  a  pavement  epithe- 
lioma containing  epidermal  nests.  In  another  the  lesion  had  origin- 
ated from  certain  sebaceous  glands.  The  patient,  a  seven-year-old 
dog,  showed  a  large  number  of  verrucous  tumours  about  the  body. 
One  of  these  the  size  of  a  hazel  nut  was  excised  ;  it  consisted  of 
masses  of  cells  similar  to  those  in  the  Malpighian  layer  of  the  skin  ;  the 


MALIGNANT   TUMOURS    IN    ANIMALS.  5gt 

central  cells  were  infiltrated  with  fat  globules  or  had  undergone  fatty 
degeneration  ;  at  several  points  these  degenerated  cells  were  sur- 
rounded by  other  flattened  cells  arranged  in  lamellae  (Fig.  94).  The 
third  consisted  of  an  epithelioma  the  alveoli  of  which  contained  small 
rounded  elements.  Sections  showed  numerous  cells  resembling  those 
described  by  various  authors  as  coccidia.  We  have  several  times 
noted  cells  of  this  character,  but  in  the  above  cases  they  were  particu- 
larly abundant  and  remarkable.  Although  the  source  of  the  cancer 
was  evident  in  the  two  first  cases  it  was  extremely  doubtful  in  the 
third. 

In  passing  we  may  also  mention  the  various  epithelial  tumours 
affecting  the  point  of  the  elbow,  thoracic  walls,  lung,  thyroid  body, 
penis,  and  lips  in  the  dog.  In  a  cat  we  saw  an  epithelioma  occupying 
the  thoracic  wall,  and  the  substance  of  the  lungs. 

Though  rarer  than  has  usually  been  described,  sarcoma  is  never- 
theless fairly  frequent  in  the  dog.  We  found  a  round-celled  sarcoma 
in  the  elbow  region,  and  a  fusiform -celled  sarcoma  on  the  buttock. 
We  had  under  observation  a  nine-year-old  sheep  dog  with  complete 
paraplegia,  accompanied,  however,  by  persistence  of  cutaneous  sensa- 
tion, due  to  a  tumour  which  had  destroyed  the  body  of  the  first 
lumbar  vertebra  ;  it  projected  considerably  into  the  neural  canal,  and 
was  almost  as  large  as  a  fowl's  egg.  This  tumour  proved  to  be  a 
fusiform  celled  sarcoma  (Fig,  95),  containing  tracts  of  osteoid  tissue, 
which  stained  rose-red  with  picrocarmine,  and  were  pierced  with 
stellate  cavities  provided  with  canaliculi,  resembhng  in  shape  osteo- 
plasts. 

In  two  horses  we  saw  lesions  resulting  from  repeated  mechani- 
cal injury.  In  one  case  a  tumour,  the  size  of  a  man's  fists,  had 
developed  on  the  anterior  margin  of  the  shoulder  beneath  the  collar. 
In  another  the  grow^th  had  existed  for  two  years.  It  was  located  on 
the  metatarsus  of  the  near  hind  limb,  a  little  above  the  fetlock,  w-as 
very  large  and  ulcerated  on  the  surface.  It  had  returned  after 
removal.  These  new  growths  were  not  true  tumours  but  chronic 
inflammatory  growths  formed  by  fibrous  tissue.  We  mention  these 
cases  because  without  recourse  to  the  microscope  thev  might  have 
been  mistaken  for  cancerous  tumours,  the  result  of  injury.  The  return 
after  operation  and  the  ulceration  of  the  surface  might  seem  to  justify 
such  a  view. 

We  have  also  seen  tumours  in  three  fowls.  In  one  case  the  feet 
were  the  seat  of  soft  new  growths.  In  the  two  others,  numerous 
tumours,  varying  in  size  between  a  haricot  bean  and  a  hazel  nut,  were 
found   in  the  liver,  spleen,  lungs,  intestine,  and  peritoneum.     These 


592 


CLINICAL   VETERINARY    MEDICINE    AND    SURGERY 


various  lesions,  which  were  unsuccessfully  used  for  inoculating  other 
fowls,  rabbits,  and  guinea-pigs,  were  all  of  similar  structure,  being 
formed  of  small,  closely  packed,  polyhedric  cells  provided  with  large 
nuclei.  A  considerable  number  of  vessels  were  seen,  but  no  stroma 
could  be  discovered.  These  peculiar  tumours  differed  considerably 
from  any  seen  in  mammals. 

To  facilitate  study  of  the  results  of  our  research   we  recapitulate 
them  in  the  form  of  a  table. 


Species 

of 
Animal. 


Dog,  38 
cases. 


Horse,  5 
cases. 


Seat  of  the  Tumours. 


Mammary  gland 

Testicle      .         .         .         . 
Facial  sinuses  and  superior 
maxilla  .  .  .  . 

Parotid  gland 
Peri-anal  glands 
Thyroid  gland    . 

Skin  .  .  .  .  . 


Lips   . 

Penis . 
Lungs 

Thoracic  wall 
Buttock      . 

Elbow  region 

Spinal  column 
Mammary  gland 
Testicle 

Facial  sinuses 


Nature  of  the  Tumours.  Number. 


Cat 
F"owl 


■{ 


Stomach     . 

Thoracic  wall 
Feet  . 
Viscera 


nd  luno's 


rAdenoid  epithelioma  . 
J  Fusiform-celled  sarcoma 
I  Chondroid  sarcoma 
|_  Osteoid  sarcoma 

Adenoid  epithelioma 
r  Alveolar  epithelioma 
\  Lymphadenoma  . 

Epithelioma  with  epidermal  "  nests" 

Adenoid  epithelioma  .... 

Epithelioma  with  small  polyhedral  cells 

Pavement  epithelioma  with  epidermal 
"  nests  "  . 
1  Small-celled  epithelioma 
L  Epithelioma  of  the  sebaceous  gland 
f  Epithelioma  with  tendency  to  scirrhous 
\      transformation 

Adenoid  epithelioma  . 

Epithelioma 

Epithelioma 

P'usiform-celled  sarcoma 
f  Round-celled  sarcoma 
\  Epithelioma 

Fusiform-celled  sarcoma 

Adenoid  epithelioma  . 

Adenoid  epithelioma  . 
r  Epithelioma 
1  Globo-cellular  sarcoma 
r  Pavement     epithelioma      with     epiderma 
\      "  nests  "  . 

Cylindrical  epithelioma 

Masses  of  polyhedral  cells 

Masses  of  polyhedral  cells 


18 


When  cancer  occurs  in  parts  accessible  to  manual  examination,  it 
first  appears  as  a  swelling,  which  gradually  increases  in  size  and  soon 
becomes  adherent  to  the  skin.  In  almost  all  cases  the  primary  lesion 
is  surrounded  by  hard,  irregular,  lymphatic  chains  running  towards 
the  neighbouring  lymphatic  glands,  which  are  enlarged.  Secondary 
tumours  next  appear,  either  around  the  new  growth  or  over  the  track 
of  the  indurated  lymphatics.  At  the  same  time  the  tumour  increases 
in  size,  becomes  bosselated  and  sometimes  ulcerated  at  certain  points. 

The  mode  of  development  of  cancer  varies  extremely.     Speaking 


MALIGNANT    TUMOURS    IN    ANIMALS.  593 

generally,  sarcoma  grows  more  rapidly  than  carcinoma,  and  although 
it  has  less  tendency  to  invade  the  skin  and  lymphatic  glands,  it  pro- 
bably more  often  becomes  generalised  in  the  viscera.  One  of  us 
reported  a  case  of  primary  sarcoma  of  the  femur  in  a  large  dog,  which 
died  in  consequence  of  invasion  of  the  lungs  ;  on  post-mortem  examina- 
tion more  than  2000  tumours  were  counted  on  the  surface  of  the 
internal  organs. 

Despite  the  existence  of  cancer  the  patient's  general  condition  may 
remain  good.  This  is  particularly  the  case  in  cancer  of  the  mammary 
gland.  Distinct  wasting  may  only  commence  after  one  or  two  years. 
When  the  lesions  become  generalised  the  animals  appear  weak  and 
depressed,  showing  a  train  of  symptoms  depending  on  the  organs 
attacked. 

As  death  approaches  the  white  blood-corpuscles  usually  increase 
in  number.  In  the  dog  just  mentioned,  the  proportion  shortly  before 
death  was  one  leucocyte  to  seventy-three  red  blood-corpuscles. 

Incomplete  ablation  of  cancerous  tumours  is  always  followed  by 
return,  the  new  tumour  generally  developing  more  rapidly  than  the 
primary.  But  early  and  total  extirpation  seems  to  give  better  results 
than  in  man.  Horses  and  dogs  which  had  been  operated  on  were 
under  observation  for  periods  of  a  year,  eighteen  months,  and  two 
years  without  showing  any  return. 

To  sum  up,  cancer  in  animals  seems,  in  a  general  sense,  less  grave 
than  in  man.  It  has  a  greater  tendency  to  remain  localised  to  the 
point  of  origin  and  returns  less  rapidly  and  less  frequently.  But 
these  differences  are  far  from  being  absolute,  and  in  spite  of  the 
reserve  with  which  we  have  spoken,  it  must  be  recognised  that  in  all 
mammals  cancer  presents  the  same  anatomical  and  clinical  characters. 

We  have  sufficiently  dwelt  on  the  microscopic  appearance  of  the 
new  growths  and  shall  not  therefore  return  to  it. 

We  simply  add  that  examination  of  tumours  in  animals  affords 
powerful  evidence  in  favour  of  the  epithethelial  origin  of  cancer. 
It  shows  that  the  tumour  presents  special  characters  indicating  its 
origin,  as  we  pointed  out  when  speaking  of  new  growths  in  the  mam- 
mary gland,  testicle,  and  skin,  and  when  describing  the  case  of  the 
horse  with  a  pavement  epithelioma  developed  on  the  cuticular  portion 
of  the  gastric  mucous  membrane.  It  is  also  interesting  to  note  that 
tumours  of  the  mammary  gland  have  a  tendency  to  develop  into 
complex  types  and  to  undergo  chondroid,  or  even  osteoid,  transforma- 
tion. This  tendency  is  also  seen  in  man,  though  in  an  infinitely 
smaller  proportion  of  cases. 


594  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY, 

Our  object  in  this  report  has  been  to  give  the  results  of  our 
personal  researches.  For  this  reason  we  make  no  mention  of  certain 
neoplasms,  like  melanotic  tumours,  which  are  very  common  and  are 
almost  always  of  sarcomatous  character  (Cornil  and  Trasbot). 

In  conclusion,  we  again  draw  attention  to  the  difficulty  of  utilizing 
old  records  in  the  synthetic  study  of  malignant  tumours,  on  account 
of  the  frequent  confusion  which  has  occurred  between  cancer  and 
parasitic,  or  tuberculous  lesions. 


PART    V. 
EXPERIMENTAL    THERAPEUTICS. 


I.— THE   TREATMENT   OF   TUBERCULOSIS. 

In  the  experiments  hitherto  made  regarding  the  serum  treatment 
of  tuberculosis  five  principal  methods  have  been  adopted  :  (i)  Injec- 
tion of  blood,  or  serum,  from  animals  regarded  as  refractory  to  tuber- 
culosis ;  (2)  injection  of  extracts  of  organs  from  such  animals  ;  (3) 
injection  of  blood  or  serum  from  animals  previously  inoculated  with 
virulent  tuberculous  material,  or  with  living  cultures  ;  (4)  injection  of 
serum  from  animals  previously  inoculated  either  with  tuberculous  pro- 
ducts, with  sterilized  cultures,  or  with  tuberculin  ;  (5)  injection  of 
serum  from  animals  inoculated  with  certain  soluble  products  derived 
from  tubercle  bacilli. 

MM.  Hericourt  and  Richet,  in  a  note  communicated  to  the 
*  Academie  des  Sciences,'  announced  the  result  obtained  by  intraperi- 
toneally  injecting  into  rabbits  already  inoculated  with  Staphylococcus 
pyosepticus,  blood  from  normal  healthy  dogs,  or  from  dogs  which  had 
been  inoculated  with  this  staphylococcus  and  had  recovered  from  the 
local  infection  thus  produced.  In  certain  cases  injection  of  normal 
blood  was  followed  by  recovery,  but  when  blood  from  prepared  dogs 
was  used  all  the  rabbits  survived. 

Concluding  from  these  results  that  the  blood  injected  exercised  a 
microbicide  action,  MM.  Hericourt  and  Richet  asked  themselves 
whether  this  influence  of  dog's  blood  did  not  apply  to  other  diseases, 
to  which  the  animal  is  but  little  sensitive,  and  they,  therefore,  extended 
the  treatment,  by  injection  of  blood,  to  certain  of  these  diseases,  among 
others  to  tuberculosis.  Experimenting  on  rabbits  inoculated  with  cul- 
tures of  bovine  or  avian  tuberculosis,  they  found  that  animals  which 
received  injections  of  dog's  blood  died  in  the  proportion  of  only 
17  per  cent.,  whilst  in  control  animals  the  mortality  was  55  per  cent. 


596  CLINICAL   VETERINARY    MEDICINE   AND   SURGERY. 

As  early  as  1881  M.  Bouchard  had  succeeded  in  increasing  the  re- 
sistance to  the  pyocyanic  bacillus  by  injecting  into  the  rabbit's  veins 
blood  or  serum  obtained  from  the  dog.  Shortly  afterwards  he  found 
that  the  serum  possessed  similar  immunising  powers  and  produced  the 
same  therapeutic  effects  as  blood  itself. 

Starting  with  these  facts  and  the  then  very  general  belief  that 
goats  were  refractory  to  tuberculosis  MM.  Bertin  and  Picq  subjected 
rabbits  inoculated  with  tuberculosis  to  injections  of  goats'  blood. 
According  to  their  observations  this  fluid  in  doses  of  2*50  grammes 
per  kilo  of  body-weight  checked  the  development  of  the  disease,  and 
even  cured  animals  when  treatment  was  commenced  shortly  after 
inoculation.  These  authors  and  M.  Bernheim  applied  this  method  of 
treatment  to  man;  M.  Lepine  also  tested  in  man  the  effects  of  injecting 
goat's  serum. 

The  experiments  undertaken  by  M.Bouchard  in  i8gi,  and  published 
in  January,  1892,  show  that  the  blood  and  serum  of  animals  which  are 
refractory  (or  were  so  considered),  and  of  the  goat  in  particular,  far 
from  having  a  favourable  influence  when  injected  into  tuberculous 
animals  often  appeared  to  exercise  an  absolutely  injurious  effect.  He 
says  : — "  As  a  whole  the  cases  inoculated  have  been  graver  and  more 
rapidly  fatal  in  the  guinea-pigs  treated  than  in  the  control  animals." 

The  end  of  the  year  1890  had  been  marked  by  an  important  dis- 
covery which  inaugurated  the  era  of  sero-therapy.  Behring  and 
Kitasato  had  discovered  the  existence  of  anti-toxic  substances  in  the 
fluids  of  animals  vaccinated  against  tetanus  and  diphtheria.  They 
had  found  that  the  blood  of  animals  rendered  refractory,  either  by 
Nicolaier's  or  Loffler's  bacillus,  had  the  power  of  neutralizing  or 
rendering  harmless  the  toxins  of  these  bacilli ;  that  this  property  ex- 
tended to  the  serum  as  well  as  to  the  unaltered  blood  ;  and  that  it 
permitted  of  definite  treatment.  Everyone  knows  the  results  of  sero- 
therapy in  diphtheria  and  tetanus. 

Attempts  were,  therefore,  made  to  effect  for  tuberculosis  what  had 
been  done  for  tetanus  and  diphtheria  ;  efforts  were  made  to  immunise 
animals  (goat,  sheep,  dog,  horse),  to  bring  about  by  various  methods 
the  production  of  tuberculous  antitoxins  in  the  bodily  fluids  of  these 
animals.  Numerous  experiments  were  undertaken  with  this  object. 
We  should  specially  mention  those  of  MM.  Hericourt  and  Richet, 
who  prepared  serum-yielding  animals  by  injecting  them  with  virulent 
tuberculous  cultures,  both  human  and  avian  ;  those  of  Behring,  who 
produced  an  antitoxic  serum  by  injecting  different  animals  with  tuber- 
culin ;  of  Nieman,  who  prepared  dogs  and  goats  by  injections  with  an 
alcoholic  extract  of  tuberculin ;    of  Maragliano,  who  first  injected  all 


THE  TREATMENT  OF  TUBERCULOSIS.  597 

the  toxic  substances  extracted  from  very  virulent  cultures  of  human 
tuberculosis  and  afterwards  a  quantity  of  tuberculin  ;  those  of  Babes 
and  Proca,  who  successively  injected  avian  and  human  tuberculin, 
followed  by  dead  bacill   of  avian  and  human  origin. 

According  to  the  investigators  who  prepared  them,  certain  of  the 
sera  thus  obtained  had  a  real  antitoxin  action  ;  they  prevented  the 
development  of  bacilli  and  secured  recovery  from  experimental  tuber- 
culosis. But  as  a  whole  the  results  seemed  very  uncertain,  and  despite 
the  optimistic  conjectures  indulged  in,  the  future  of  serum  treatment 
for  tuberculosis  remained  undecided. 

The  experiments  of  Gilbert,  Roger,  and  Cadiot  were  commenced 
in  1892.  Observed  facts  and  experiments  had  shown  that  certain 
animals  previously  regarded  as  refractory  to  tuberculosis,  among  others 
the  goat  and  dog,  were  in  reality  moderately  sensitive  to  it ;  but, 
struck  by  the  resistance  of  the  Gallinacese  to  mammalian  tuberculosis, 
these  observers  studied  the  action  produced  by  the  defibrinated  blood 
and  serum  of  birds  on  its  evolution.  In  order  to  obtain  sufficient 
quantities  of  blood  and  serum  they  chose  the  turkey,  in  which 
puncture  of  the  humeral  vein  yields  a  considerable  quantity  of  blood, 
and  which  can  be  bled  two  or  three  times  per  month  for  a  consider- 
able period. 

Several  series  of  experiments  made  on  the  guinea-pig  showed  that 
the  serum  and  defibrinated  blood  of  birds  injected  under  the  skin  or 
into  the  peritoneum  have  no  greater  action  on  tuberculosis  than 
similar  fluids  obtained  from  mammals.  They  in  no  way  check  the 
course  of  the  disease ;  and,  in  fact,  a  certain  number  of  the  animals 
treated  died  before  the  controls. 

They  afterwards  studied  the  action  of  serum  from  turkeys 
previously  injected  with  tuberculous  material  by  way  of  the  veins. 
For  several  months  these  birds  were  periodically  injected  with  one 
half  to  one  fluid  drachm  of  an  emulsion  prepared  with  tuberculous 
products,  most  frequently  from  the  dog.  The  injections  were  repeated 
every  week  or  fortnight,  the  total  number  of  virulent  injections  vary- 
ing between  six  and  twelve.  Some  weeks  after  the  last,  when  bacilli 
had  disappeared  from  the  blood,  the  defibrinated  blood  or  serum  was 
used.  In  a  certain  number  of  guinea-pigs  treated  at  the  therapeutical 
laboratory  of  the  Faculty  of  Medicine  with  serum  thus  obtained,  the 
development  of  tuberculosis  was  manifestly  less  rapid  than  in  control 
animals. 

In  another  series  of  experiments  serum-yielding  animals  were  pre- 
pared by  injecting  into  the  veins  or  peritoneum  doses    of  fifteen  to 


59^  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

forty-five  minims,  either  of  diluted  tuberculin,  or  of  living  or  dead 
cultures  of  canine  tuberculosis,  suspended  in  sterilised  water.  Except 
in  birds,  in  which  they  produced  disturbance,  these  injections  were 
repeated  eight  to  twelve  times,  at  intervals  of  one  to  two  weeks. 

The  sera  thus  obtained  were  of  no  value  ;  either  the  animals 
treated  died  of  tuberculosis  like  the  controls,  or  both  subjects  and 
controls  showed  tuberculous  lesions  similar  in  point  of  intensity  and 
generalisation  when  (regarding  it  as  useless  to  prolong  the  experiment 
until  the  subjects  died)  the  survivors  were  killed. 

It  is  known  that  in  tuberculous  patients  specific  buccal  lesions  are 
relatively  rare,  although  tubercle  bacilli  are  to  be  met  with  in  the 
mouth  of  many  consumptives,  being  carried  there  by  expectoration. 
Starting  with  this  fact,  M.  Bloch,  Doctor  at  the  National  Asylum  at 
Vincennes,  propounded  the  question  whether  saliva  might  not  exercise 
an  attenuating  action  on  the  tuberculous  virus  and  on  the  infection  it 
produces. 

In  tuberculosis  especially  every  theory  founded  on  observed  facts 
deserves  to  be  submitted  to  experimental  proof,  and  therefore  M. 
Cadiot  undertook  an  inquiry  into  the  influence  which  injections  of 
saliva  might  exercise  on  the  development  of  the  disease. 

Guinea-pigs  rendered  tuberculous  by  intra-peritoneal  inoculation  of 
a  culture  of  canine  tuberculosis  emulsified  in  sterilised  water  were 
treated  with  parotid  saliva  collected  aseptically  from  a  horse.  On  the 
ist  September,  i8g8,  M.  Cadiot  commenced  the  treatment  of  a  pre- 
liminary group  of  eight  guinea-pigs  inoculated  on  August  14th,  and  of 
a  second  group  of  eight  guinea-pigs  inoculated  on  the  31st  August. 

In  each  series  five  subjects  were  treated.  In  three,  sixteen  to  thirty- 
two  minims  of  saliva  were  injected  into  the  peritoneum  every  two  or 
three  days ;  in  the  other  two  the  injection  was  made  hypodermically. 
Three  animals  were  reserved  as  controls. 

On  the  22nd  September  one  guinea-pig  of  the  first  group,  which 
had  been  inoculated  eight  times  in  the  peritoneum,  died.  On  autopsy 
enormous  tuberculous  lesions  were  found  in  the  liver,  spleen,  and 
epiploon  ;  the  lymphatic  glands  were  enlarged,  and  numerous  granu- 
lations were  seen  in  the  lungs. 

A  guinea-pig  of  the  second  group  died  on  the  29th  September 
after  the  eleventh  injection.  It  also  showed  tuberculous  lesions  in  the 
liver,  spleen,  epiploon,  and  lungs,  though  the  lesions  were  much  less 
marked  than  in  the  first. 

A  second  animal  of  the  first  group,  which  had  received  380  minims 
of  saliva  in  the  peritoneum,  died  on  the  30th   September.     The  post- 


THE  TREATMENT  OF  TUBERCULOSIS.  599 

mortem  examination  showed  hepatic  and  splenic  lesions  of  an  even 
more  marked  character  than  in  the  first  subject.  The  liver  was 
enormous,  yellowish  in  colour,  and  crammed  with  tubercles.  There 
were  numerous  pulmonary  granulations. 

Although  these  results  were  discouraging,  the  injections  were  con- 
tinued until  the  loth  October.  At  this  time  both  the  animals  treated 
and  the  controls  were  very  thin.  The  investigation  was  terminated 
by  killing  the  surviving  guinea-pigs.  All  showed  tuberculous  lesions, 
and  except  in  the  case  of  two  guinea-pigs  belonging  to  the  second 
group,  treated  by  subcutaneous  injections,  these  lesions  were  more 
intense  and  more  generalised  in  the  animals  which  had  been  injected 
than  in  the  controls. 

The  parotid  saliva  of  the  horse  has  no  attenuating  action  in  vitro 
on  Koch's  bacillus.  M.  Cadiot  mixed  lOO  minims  of  saliva  with  a 
quantity  of  the  same  tuberculous  culture  as  was  used  for  the  preceding 
experiments.  After  three  days  of  contact,  during  which  every  pre- 
caution was  taken  to  avoid  changes  in  the  emulsion,  it  was  injected 
into  the  peritoneum  of  two  guinea-pigs.  At  the  same  time  a  portion 
of  the  culture  equal  in  quantity  to  that  which  had  been  added  to  the 
saliva  was  saved,  and  having  been  emulsified  in  a  little  sterilised  water 
was  injected  into  the  peritoneum  of  two  other  guinea-pigs.  The  four 
animals  were  killed  at  the  end  of  forty  days  and  showed  tuberculous 
lesions  of  the  liver,  spleen,  and  lungs.  In  the  first  two  peritoneal 
granulations  were  found,  but  in  the  others  nothing  abnormal  was 
discovered. 


II.— THE  SERUM  TREATMENT  OF  GLANDERS. 

In  glanders,  as  in  tuberculosis,  attempts  have  been  made  to  utilise 
in  treatment  blood  and  serum  from  refractory  animals,  Malzew  and 
some  other  experimenters  claim  to  have  been  successful  in  immunising 
animals  by  injections  of  ox  serum.  MM.  Chenot  and  Picq  by  thus 
treating  guinea-pigs  rendered  glanderous  by  inoculation  with  virus 
taken  from  the  horse  succeeded  in  curing  seven  cases  out  of  ten. 
Similar  attempts  made  by  MM.  Nocard  and  Leclainche  failed. 

During  the  past  two  years  I  have  treated  with  defibrinated  ox  blood 
and  serum,  and  afterwards  with  defibrinated  blood  and  serum  from 
birds,  several  series  of  guinea-pigs  which  had  been  inoculated  by 
scarifying  the  skin  of  the  flank  or  face  and  applying  glanders  pus. 
The  results  were  as  disappointing  as  those  in  connection  with  tuber- 
culosis. The  injections  did  not  seem  to  me  to  exercise  any  real 
influence  on  the  local  lesions,  or  on  the  development  of  disease.  In 
the  majority  of  cases  they  did  not  prevent  extension  of  the  ulcer, 
enlargement  of  lymphatic  glands,  or  production  of  visceral  lesions. 
In  some  cases  the  local  ulcer  healed,  but  this  also  occurred  in  a  pro- 
portion of  the  control  animals.  Such  a  result  is  not  uncommon  in 
chronic  glanders  in  the  guinea-pig,  and  as  the  secondary  lesions  are 
irregular  in  intensity  and  distribution,  being  sometimes  confined  to  a 
few  granulations  or  small  caseous  centres,  it  is  easy  to  understand  why 
certain  authors  came  to  believe  in  the  efficacy  of  serum  from  refractory 
animals. 

I  attempted  to  prepare  an  antitoxic  serum  by  the  same  methods  as 
had  been  followed  in  connection  with  tuberculosis.  Turkeys  were 
intra-venously  and  hypodermically  injected  with  sterilised  glanders 
cultures  and  mallein.  These  birds  proved  fairly  sensitive  to  the  action 
of  the  glanders  poison.  Whilst  they  resisted  large  doses  of  tuberculin 
and  tubercle  bacilli  fairly  well,  they  suff'ered  much  more  from 
repeated  injections  of   mallein   or  of  glanders  bacilli.       Nevertheless 


THE    SERUM    TREATMENT    OF    GLANDERS.  6oT 

several  birds  which  had  received  eight  to  twelve  hypodermic  or  intra- 
venous injections  survived  for  some  months. 

With  serum  thus  obtained  I  treated  during  October  and  November, 
1898,  some  guinea-pigs  inoculated  in  the  flank  by  scarification  with 
glanders  virus  taken  from  the  horse.  From  twenty  animals  thus 
inoculated  on  the  23rd  September,  1898,  I  chose  ten  in  which  the  local 
lesions  were  well  developed  and  practically  of  uniform  intensity.  All 
showed  ulcers  with  indurated  bases,  accompanied  in  most  by  inflam- 
mation of  the  precrural  lymphatic  glands.  Seven  of  these  guinea-pigs 
were  injected  every  third  or  fourth  day  with  thirty  to  eighty  minims  of 
serum ;  five  were  injected  subcutaneously  and  two  intra-peritoneally.  In 
four  the  injections  were  continued  for  five  weeks  (4th  October  to  loth 
November).  In  three  the  ulcer  healed  with  fair  rapidity,  and  in  general 
wasting  appeared  less  marked  than  in  the  controls,  but,  like  the  latter, 
the  animals  treated  showed  various  secondary  complications,  such  as 
orchitis,  abscess  formation,  and  cutaneous  ulcers  ;  and  although  three 
months  after  inoculation  one  was  still  in  fairly  good  condition  and  free 
of  apparent  complications,  it  proved  to  be  suffering  from  grave  visceral 
lesions. 

Two  of  the  injected  animals  and  a  control  died  before  the  end  of 
the  first  month  ;  three  injected  animals  and  the  two  last  controls 
during  the  course  of  the  second  month  ;  and  one  of  the  two  surviving 
animals  which  had  been  treated  on  the  seventy-fourth  day.  On 
autopsy  all  these  animals  showed  multiple  visceral  lesions,  but 
principally  inflammation  of  lymphatic  glands,  granulations,  and  more 
or  less  numerous  nodules  in  the  liver,  spleen,  or  lungs.  On  post-mortem 
examination  the  last  of  the  animals,  killed  on  the  27th  December  (after 
ninety-five  days),  also  showed  lesions  in  the  lymphatic  glands,  liver, 
and  spleen. 

I  shortly  transcribe  two  of  the  records  concerning  injected 
animals  : 

(i)  Male  guinea-pig,  weighing  thirteen  ounces,  inoculated  on  the 
23rd  September.  On  the  29th  there  was  marked  swelling  of  the  scarified 
region.  On  the  4th  October  a  circular  ulcer,  the  size  of  a  threepenny 
piece,  had  developed  ;  its  base  was  cupped,  greyish,  dotted  with  red 
points,  and  surrounded  by  an  indurated  zone ;  the  animal's  weight 
was  twelve  ounces  and  a  half. 

On  the  5th  the  first  injection  was  made.  On  the  loth  the  pre- 
crural lymphatic  glands  were  the  size  of  a  haricot  bean,  and  a  sar- 
cocele  had  developed.  The  ulcer  was  stationary.  On  the  i6th  the 
external  lesions  were  in  the  same  condition,  but  the  animal  was 
already  much  wasted ;  weight  eleven  ounces  and  three  quarters.     On 


6o2  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

the  23rd  there  was  discharge  from  both  nostrils  ;  respiration  was  painful 
and  wheezy.  The  animal  died  on  the  27th  ;  weight  of  the  cadaver  ten 
ounces.  It  had  been  injected  six  times,  and  had  received  in  the  sub- 
cutaneous connective  tissue  of  the  abdomen  five  and  a  half  fluid 
drachms  of  serum. 

Autopsy. — The  ulcers  in  the  flank  and  the  enlarged  precrural  lym- 
phatic glands  were  connected  by  a  fine  knotted  lymphatic  cord.  An 
abscess  the  size  of  a  haricot  bean  had  developed  in  the  thickness  of 
the  abdominal  wall  at  the  point  where  the  injections  had  been  made. 
Granulations  and  a  few  purulent  nodules  were  present  in  the  liver, 
spleen,  and  lungs.  There  was  suppurative  orchitis  on  the  left  side, 
acute  inflammation  of  the  peritoneal  covering  of  the  cord.  The  upper 
portion  of  the  vaginal  sheath  was  obliterated  by  an  extensive  fibrous 
exudate. 

(2)  Male  guinea-pig,  weighing  fourteen  ounces,  inoculated  on  the 
23rd  September.  On  the  ist  October  the  point  of  inoculation  showed 
a  large  bright  red  indurated  patch.  On  the  4th  a  grey,  cupped  ulcer 
had  developed ;  the  margins,  from  which  the  hair  had  fallen,  were 
whitish  in  colour.  Enlargement  of  the  precrural  glands  as  large  as 
a  pea. 

First  inoculation  on  the  5th  October.  On  the  i6th  the  ulcer  in 
the  flank  was  slightly  enlarged,  and  the  precrural  glands  formed  a 
swelling  the  size  of  a  haricot  bean  ;  weight  twelve  ounces  and  a  quarter. 
On  the  25th  the  appearance  of  the  ulcer  in  the  flank  had  improved  ; 
its  borders  were  less  red  and  hard.  The  right  testicle  was  inflamed. 
On  the  8th  November  a  cutaneous  ulcer  appeared  towards  the  centre 
of  the  dorsal  region.  On  the  22nd  this  ulcer  and  that  in  the  flank 
were  healing.  The  orchitic  swelling  was  as  large  as  a  hazel  nut. 
Died  on  the  loth  December.  Weight  of  the  cadaver  ten  ounces 
and  three  quarters.  This  guinea-pig  had  received  nearly  eight  fluid 
drachms  of  serum  in  eleven  injections. 

Autopsy. — The  ulcer  in  the  flank  had  healed  ;  that  on  the  back  only 
measured  one  sixth  of  an  inch  across.  There  was  generalised  inflam- 
mation of  the  lymphatic  glands,  the  centres  of  which  were  caseous. 
The  liver  contained  some  purulent  nodules  ;  the  spleen  was  enormous, 
weighing  one  and  a  quarter  ounces,  and  was  bosselated  with  nodules 
and  caseous  centres.  Three  or  four  small  pulmonary  tubercles.  Sup- 
purative orchitis. 

Nine  other  guinea-pigs,  inoculated  by  scarifying  the  skin  of  the  face 
and  applying  glanders  pus  obtained  from  the  horse,  were  treated 
with   serum  from  turkeys  injected  with  mallein,  and  afterwards  with 


THE    SERUM    TREATMENT    OF    GLANDERS.  603 

living  glanders  bacilli.  The  results  were  similar  to  the  preceding. 
The  disease  developed  in  the  injected  animals  much  as  in  the  con- 
trols. I  was  unable  to  note  any  well-marked  differences  in  the 
development  and  characters  of  the  initial  lesion,  in  those  of  the  pre- 
auricular and  pre-scapular  lymphatic  infections,  or  in  those  of  the 
visceral  lesions. 

The  favourable  influence  which  serum  appears  to  exercise  on  some 
subjects  is  exclusively  due  to  the  animal's  individual  power  of  resist- 
ance, and  to  the  peculiar  way  in  which  glanders  often  develops  in 
guinea-pigs.  This  is  well  shown  by  the  fact  that  progress  is  slow 
and  development  localised  just  as  frequently  among  control  animals  as 
among  animals  subjected  to  treatment. 


III.— THE  ACTION  OF  VANADINE. 

For  some  years  attempts  have  been  made  to  utilise  in  practice  the 
remarkable  oxidising  properties  of  vanadium  and  its  compounds. 
Vanadic  acid,  vanadate  of  soda,  and  vanadine  have  all  been  studied, 
and  have  been  recommended  in  the  treatment  of  pneumonia,  rheu- 
matism, and  tuberculosis. 

I  have  made  an  experimental  and  therapeutic  study  of  various 
preparations  of  vanadium,  but  especially  of  vanadine.  Considerable 
doses  of  vanadine  may  be  injected  into  the  connective  tissue  or  veins 
of  animals  without  producing  any  toxic  symptoms,  in  the  guinea-pig  a 
subcutaneous  injection  of  thirty  to  fifty  minims  produces  no  appre- 
ciable disturbance.  In  most  cases  nothing  abnormal  follows  hypo- 
dermic injection  of  i  c.cm.  per  loo  grammes  (approximately  fifteen 
minims  per  three  ounces)  of  body-weight,  but  a  double  dose  is  fatal. 
Guinea-pigs  of  400  to  600  grammes  (approximately  twelve  and  a  half 
ounces  to  eighteen  and  a  half  ounces)  in  weight  bear  hypodermic  or 
intra-peritoneal  injections  with  i  c.cm.  (fifteen  minims)  of  vanadine 
repeated  every  second  or  third  day,  for  a  considerable  period.  In  the 
rabbit  intra-venous  injection  of  i  c.mm.  of  vanadine  per  kilogramme  is 
well  borne,  and  the  animal  often  survives  doses  four  times  as  large.  A 
rabbit  of  five  pounds  weight,  which  had  received  120  minims  of 
vanadine  in  the  auricular  vein,  showed  grave  symptoms  (convulsions, 
paresis,  dyspnoea,  and  prostration),  which  continued  for  several  hours, 
but  the  animal  gradually  recovered.  A  dog,  weighing  sixteen  and  a 
half  pounds,  showed  no  disturbance  after  an  intra-venous  injection  of 
120  minims  of  vanadine ;  nor  was  anything  noted  in  a  dog  weighing 
eighty  one  and  a  half  pounds,  which  received  into  the  saphenous  vein 
two  fluid  ounces  of  vanadine.  A  horse  weighing  528  lbs.  showed 
nothing  appreciable  after  a  first  intra-venous  injection  of  fourteen  fluid 
drachms  of  vanadine,  followed  some  days  later  by  a  further  injection 
of  two  fluid  ounces.  In  a  horse  weighing  594  lbs.,  an  injection  of 
twenty-eight  fluid  drachms  of  vanadine  into  the  jugular  produced  rest- 
lessness, trembling,  soft  evacuations,  and  lowering  of  temperature  to 
the  extent  of  i'^  C. 


THE   ACTION    OF    VANADINE.  605 

Excessive  doses  of  vanadine  produce  a  series  of  grave  symptoms, 
but  particularly  nausea,  vomiting  of  food  or  glairy  material  followed 
by  blood,  diarrhoea,  soon  succeeded  by  blood-stained  evacuations, 
lively  thirst,  apoplectiform  attacks,  acute  pain,  shown  by  groaning  or 
crying,  slowing  of  the  circulation  and  respiration,  attacks  of  dyspnoea, 
and  finally  depression  of  temperature.  I  noted  all  these  troubles  in  a 
dog  weighing  thirteen  pounds  three  ounces  which  received  five  and  a 
half  fluid  drachms  of  vanadine  in  the  saphenous  vein. 

I  have  used  vanadine  in  the  treatment  of  certain  diseases  in 
the  horse  and  dog,  principally  pneumonia,  the  abdominal  form  of 
influenza,  distemper  and  its  complications,  wasting  diseases,  and 
in  persistent  loss  of  appetite  due  to  gastro-intestinal  atony.  I  have 
injected  it  into  the  subcutaneous  connective  tissue  in  doses  of  fifteen 
to  eighty  minims  in  the  dog,  and  of  five  and  a  half  to  seven  fluid 
drachms  in  the  horse.  At  the  present  time  I  have  not  collected 
sufficiently  numerous  statistics  to  show  how  much  should  be  given  in 
the  treatment  of  acute  diseases,  but  in  such  affections,  and  particu- 
larly in  pneumonia,  where  the  local  lesion  is  far  from  possessing  the 
importance  attributed  to  it,  where  the  morbid  symptoms  are  due 
to  diminution  in  the  aerating  surface,  to  auto-intoxication,  to 
diminished  elimination,  or  to  the  transformation  of  poisons,  vanadine, 
like  every  agent  possessing  oxidising  properties,  appears  to  have  a 
favourable  effect.  Injected  in  small  doses  repeated  daily,  or  every 
second  or  third  day,  it  acts  as  a  tonic,  increases  or  restores  the  appe- 
tite, stimulates  nutrition,  favours  assimilation,  arouses  the  forces,  and 
improves  the  condition  of  emaciated  animals.  It  may,  perhaps,  prove 
of  service  in  the  treatment  of  chronic  affections  with  loss  of  strength 
or  wasting. 

I  have  also  studied  its  effects  on  guinea-pigs  rendered  tuberculous 
by  injecting  cultures  of  canine  origin  emulsified  in  sterilised  water. 
Eight  guinea-pigs  were  thus  inoculated  on  the  gth  August,  i8g8,  in  the 
subcutaneous  connective  tissue  of  the  flank,  and  a  second  series  of 
eight  guinea-pigs  in  the  peritoneum.  Two  animals  of  each  series  were 
preserved  as  controls  ;  the  others  received  every  third  or  fourth  day" a 
hypodermic  injection  of  a  few  drops  up  to  fifteen  minims  of  vanadine. 
These  injections  were  begun  on  the  17th  August,  and  continued  until 
the  15th  October. 

During  the  course  of  the  research  five  guinea-pigs  died ;  three 
inoculated  in  the  peritoneum — two  under  treatment,  and  one  control ; 
two  inoculated  under  the  skin — one  treated  and  one  control.  On 
post-mortem  examination  all  showed  more  or  less  generalised  lesions, 
depending  on  the  time  which   had  elapsed  since  inoculation.     In  the 


6o6  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

guinea-pig  under  treatment  the  seat  of  inoculation  in  the  flank  showed 
a  large  tuberculous  ulcer. 

Of  the  survivors,  those  under  treatment,  equally  with  the  controls, 
gradually  lost  weight ;  in  no  case  where  an  ulcer  had  developed  in  the 
flank  after  inoculation  did  it  heal. 

All  the  guinea-pigs  were  killed  on  the  15th  October,  and  all  showed 
tuberculous  lesions.  In  many  of  those  treated  with  small  doses  of 
vanadine  the  lesions  were  only  a  little  less  numerous  or  less  diffused 
than  in  the  others. 

MM.  Laran  and  Hallion  obtained  very  interesting  results  by  treat- 
ing guinea-pigs,  rendered  tuberculous  by  subcutaneous  inoculation, 
with  very  small  hypodermic  injections  of  vanadic  acid.  Under  the 
influence  of  these  injections  M.  Laran  has  "  often  seen  healing  of 
tuberculous  ulcers  in  animals.  In  a  guinea-pig  thus  inoculated  and 
treated  by  vanadic  acid  death  was  postponed  for  a  year  and  a  half. 
M.  Hallion,  who  studied  the  pulmonary  lesions  histologically,  noted 
"very  marked  fibrous  transformation." 


IV.— INTRA-VENOUS  INJECTIONS  OF  IODINE. 

In  veterinary  practice  very  few  substances  are  introduced  directly 
into  the  blood,  and  we  may  say  that  until  now  this  method  of 
administering  medicines  has  scarcely  extended  beyond  the  laboratories 
and  the  text  books.  Although  the  first  attempts  at  utilising  certain 
remedies,  and  iodine  in  particular,  by  intra-venous  injection  are  fairly 
old,  it  was  long  believed  that  the  method  was  dangerous,  and  that 
iodine  introduced  into  the  blood-stream  would  cause  sudden  death 
by  producing  changes  in  the  brain  and  spinal  cord.  Such  an  accident, 
in  fact,  followed  certain  intra-venous  injections  of  iodine  in  the  horse, 
but  is  explained  without  difficulty  by  the  excessive  doses  and  the 
method  of  procedure. 

The  credit  of  having  first  drawn  attention  to  the  remarkable 
tolerance  of  the  blood  towards  iodine  solutions  is  due  to  Cezard,  a 
veterinary  surgeon  of  Verennes-en-Argonne,  in  his  '  Memoire  sur  la 
Medication  Antivirulente '  (1874),  who  stated  that  he  injected  into  the 
jugular  vein  of  a  horse  weighing  1056  lbs.,  which  was  suffering  from 
chronic  glanders,  two  drachms  of  iodine  and  four  drachms  of  potassium 
iodide  in  one  dose.  This  injection  being  made  slowly  only  produced  a 
little  temporary  excitement ;  the  animal  took  food  almost  immediately 
afterwards,  and  was  worked  two  hours  later.  The  author  adds,  "  For 
intra-venous  injection  a  two  per  cent,  solution  may  be  used,  of  which 
a  medium-sized  horse  will  take,  without  inconvenience,  twelve  and  a 
half  ounces  at  a  dose."  Four  per  cent,  to  five  per  cent,  solutions  are 
also  without  danger  provided  they  be  injected  slowly.  In  this  way 
from  two  and  a  half  to  ten  drachms  of  iodine  may  be  given  to  large 
animals  in  twenty-four  hours." 

Rossbach,  who  made  experiments  in  this  connection,  also  states 
that  intra-venous  injection  of  relatively  large  doses  of  iodine  produce 
no  complications  in  the  horse. 

More  recent  experiments  have  shown  that  other  animals  also 
tolerate  iodine  and  the  iodides  when  introduced  directly  into  the 
blood.  According  to  Bohm  the  dog  shows  no  particular  disturbance 
after  injection  of  an  aqueous  solution  in  the  proportion  of  '15  to  '22 
grain  of  iodine  per  pound  of  body-weight,  the  iodine  being  dissolved 


6o8  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

by  the  addition  of  two  or  three  times  its  weight  of  sodium  iodide ;  but 
a  dose  of  "3  grain  per  pound  of  body-w^eight  produced  general  weak- 
ness, difficulty  in  respiration,  and  in  some  cases  convulsions  and  death 
in  from  twelve  to  twenty-four  hours.  G.  See  and  M.  Lapicque  saw  no 
special  disturbance  in  a  dog  weighing  17  lbs.  3  oz.,  into  whose 
saphenous  vein  they  slowly  injected  at  intervals  of  a  quarter  of  an  hour 
two  doses  of  fifteen  grains  of  potassium  iodide. 

Iodine  when  directly  introduced  into  the  blood  probably  assumes 
the  condition  of  sodium  iodide,  or  combines  with  albumen,  forming 
unstable  compounds,  which  disengage  iodine  in  contact  with  living 
protoplasm.  Elimination  by  the  kidney  commences  rapidly.  At  the 
end  of  a  few  minutes  iodine  can  be  detected  in  the  urine  in  the  condi- 
tion of  sodium  iodide,  but  a  portion  remains  in  the  blood,  and  the  drug 
appears  to  have  a  special  predilection  for  the  muscles,  kidney,  and 
brain.  M.  Gallard  found  that  it  is  retained  in  the  latter  in  consider- 
able quantities. 

In  order  to  study  the  therapeutic  action  of  iodine  and  its  use  in  the 
treatment  of  certain  animal  diseases,  I  first  determined  the  dose  which 
could  without  danger  be  introduced  into  the  blood.  I  prepared  solu- 
tions varying  in  strength  from  i  per  cent,  up  to  5  per  cent.,  the  iodine 
being  dissolved  by  the  addition  of  potassium  iodide  (iodine  i,  potas- 
sium iodide  i"5,  water  q.  s.).  My  experiments  on  animals  of  different 
species  have  given  results  which,  while  confirming  the  tolerance  of  the 
organism  for  iodine,  show  that  it  has  been  greatly  exaggerated,  and 
that  small  doses  produce  very  appreciable  results.  The  following 
records  are  interesting  in  this  respect : 

(i)  Dog,  weighing  39I  lbs.,  received  at  2  p.m.  on  the  14th  Feb- 
ruary, 1898,  an  injection  of  five  and  a  half  fluid  drachms  of  a  i  per 
cent,  iodine  solution  into  the  saphenous  vein.  No  manifest  disturb- 
ance. 

(2)  Dog,  weighing  4if  lbs.,  received  at  3  p.m.  on  the  i8th  Feb- 
ruary, an  injection  of  one  fluid  ounce  of  a  i  per  cent,  iodine  solution 
into  the  saphenous  vein.  At  the  end  of  an  hour  and  a  half  restlessness 
appeared,  followed  by  signs  of  depression  and  shivering  fits,  at  first 
localised  in  certain  regions,  especially  in  the  crural  and  gluteal  muscles, 
but  afterwards  generalised.  At  5  p.m.  the  temperature  had  risen  to 
the  extent  of  h°  C,  and  the  heart's  action  was  slightly  accelerated.  A 
little  later  the  symptoms  diminished ;  at  8  p.m.  they  had  disappeared  ; 
the  animal  was  bright,  lively,  and  ate  its  food  readily. 

(3)  Dog,  weighing  ygl  lbs.,  received  at  3  p.m.  on  the  20th  Feb- 
ruary, an  injection  of  six  and  a  half  fluid  drachms  of  a  5  per  cent, 
iodine  solution,  i.e.  a  little  more  than  '2  grain  of  iodine  per  pound  of 


INTRA-VENOUS    INJECTIONS    OF    IODINE.  609 

body-weight,  in  the  saphenous  vein.  In  a  quarter  of  an  hour  it  showed 
signs  of  restlessness  and  whined  a  Httle.  Twenty  minutes  later  slight 
localised  intermittent  trembling  occurred,  and  gradually  became 
accentuated  and  generalised.  The  trembling  fits  afterwards  dimin- 
ished, and  finally  disappeared  at  the  end  of  four  hours.  At  8  p.m.  the 
animal  showed  no  disturbance  and  readily  ate.  During  the  night 
urine  resembling  that  of  hemoglobinuria  was  passed. 

(4)  A  dog,  weighing  30I  lbs.,  received  at  10  a.m.  on  the  24th  Feb- 
ruary an  injection  of  three  fluid  drachms  of  a  5  per  cent,  iodine 
solution  ("3  grain  per  pound  of  body-weight)  in  the  jugular  vein.  In  a 
few  minutes  faeces  were  passed.  Except  for  signs  of  restlessness  no 
manifest  disturbance ;  only  a  few  shivering  attacks.  During  the 
afternoon  the  dog  passed  blackish  haemoglobinuric  urine ;  no  after- 
symptoms. 

(5)  A  goat,  weighing  81^  lbs.,  received  at  2  p.m.  on  the  25th  Feb- 
ruary in  the  jugular  vein  an  injection  of  seven  fluid  drachms  of  a  5 
per  cent,  iodine  solution  ('26  grain  of  iodine  per  pound  of  body- 
weight).  Temperature  before  injection  39*2°  C.  At  3  p.m.  masti- 
catory movements  were  made.  At  4  p.m.  slight  trembling  of  the 
muscles  of  the  quarter  and  thigh,  passage  of  haemoglobinuric  urine. 
At  6  p.m.  temperature  40"6°  C. ;  prostration ;  the  trembling  attacks 
persisted.  At  8  p.m.  temperature  40*2°  C.  ;  fresh  passage  of  haemo- 
globinuric urine.     After  this  the  symptoms  gradually  disappeared. 

(6)  A  cow,  weighing  620I  lbs.,  received  at  9  a.m.  on  the  25th  Feb- 
ruary an  injection  into  the  jugular  vein  of  two  fluid  ounces  of  a  5  per 
cent,  solution  of  iodine  ('07  grain  per  pound  of  body-weight).  At  the 
end  of  fifteen  minutes,  salivation  ;  twenty  minutes  later,  passage  of 
normal  faeces  and  yellowish  urine ;  no  manifest  disturbance  of  circu- 
lation or  respiration.  At  3  p.m.  slight  trembling  attacks  in  the  hind 
quarters,  continuing  for  two  hours ;  hyperthermia,  which  attained  its 
maximum  (i"4°  C.)  at  the  eighth  hour.  At  4  p.m.  passage  of  brownish 
haemoglobinuric  urine.     During  the  night  the  symptoms  disappeared. 

(7)  A  horse,  weighing  525J  lbs.,  received  at  i  o'clock  on  the  28th 
February  an  injection  of  eleven  fluid  drachms  of  a  i  per  cent,  iodine 
solution.  At  the  end  of  a  few  minutes  fa;ces  were  passed:  Half  an 
hour  later  trembling  appeared,  at  first  localised  in  the  hind  limbs,  but 
soon  becoming  generalised ;  it  diminished  rapidly,  and  disappeared  in 
an  hour. 

At  2  p.m.  next  day  received  an  injection  of  thirteen  and  a  quarter 
fluid  drachms  of  the  same  solution.  Immediately  before  injection 
temperature  39*3°  C,  respirations  12,  pulse  45.  Faeces  were  passed  at 
the  end  of  three  minutes.     12.30  p.m.,  trembling  movements  in  the 


6lO  CLINICAL   VETERINARY    MEDICINE   AND    SURGERY. 

vasti  and  gluteal  muscles,  soon  extending  to  all  the  hind  limbs,  and 
afterwards  to  the  whole  body  ;  slight  ptyalism  and  grinding  of  the  jaws  ; 
ears  and  extremities  cold.  At  3  p.m.  temperature  39"8°  C. ;  respiration 
and  circulation  slightly  disturbed  ;  generalised  trembling  ;  somnolence. 
The  symptoms  afterwards  disappeared. 

(8)  A  horse,  weighing  533-^  lbs.,  received  at  g  a.m.  on  the  nth 
March  an  injection  in  the  jugular  vein  of  fifteen  and  a  quarter  fluid 
drachms  of  a  5  per  cent,  iodine  solution  ('07  grain  per  pound  of  body- 
weight).  Before  injection  temperature  38*0°  C,  respirations  17,  pulse 
45.  During  the  succeeding  two  hours  the  temperature  rose  appre- 
ciably ;  the  respiration  and  circulation  became  more  rapid.  At 
11.30  a.m.  muscular  trembling,  salivation,  grinding  of  the  jaws,  cough, 
and  slight  weeping  appeared ;  these  troubles  persisted  for  two  or  three 
hours.  At  I  p.m.  temperature  39"i°  C,  respirations  30,  pulse  78;  the 
respiration  suggested  dyspnoea.  An  hour  later  the  trembling  dimin- 
ished ;  the  circulation  and  respiration  became  slower,  and  the  tempera- 
ture fell.     No  after  complications. 

(9)  A  horse,  weighing  682  lbs.,  received  at  3  p.m.  on  the  i8th  March 
in  the  jugular  vein  seventeen  fluid  drachms  of  a  5  per  cent,  solution  of 
iodine  ("07  grain  per  pound  of  body-weight).  Before  injection  tempe- 
rature 38*2°  C,  respirations  18,  pulse  46.  At  the  end  of  half  an  hour 
slight  salivation,  grinding  of  the  jaws,  and  acceleration  of  breathing 
(twenty-five  per  minute).  At  4  p.m.  trembling,  especially  marked  in 
the  hind  limbs  and  face  ;  passage  of  hard  faeces  and  flatus.  Tempera- 
ture 38*7°  C.  ;  respirations  22  ;  pulse  45.  At  5  p.m.  passage  of  fasces 
moister  than  on  the  preceding  occasion  ;  the  passage  of  flatus  and  the 
trembling  persisted.  Temperature  39' 1°  C. ;  respirations  15  ;  pulse  42. 
At  6.10  p.m.  passage  of  haemoglobinuric  urine  ;  slight  trembling.  At 
7  p.m.  the  animal  appeared  a  little  depressed,  but  otherwise  showed 
nothing  abnormal. 

(10)  A  horse,  weighing  902  lbs.,  received  at  2.50  p.m.  on  the  21st 
March  an  injection  in  the  jugular  vein  of  twenty-two  fluid  drachms  of 
a  5  per  cent,  iodine  solution  ("07  grain  per  pound  of  body-weight). 
Before  injection  temperature  38°  C. ;  pulse  38 ;  respirations  10.  At 
the  end  of  a  quarter  of  an  hour  grinding  of  the  jaws  and  salivation  ; 
expulsion  of  flatus.  Fifteen  minutes  later  temperature  38"5°  C.  ;  pulse 
38  ;  respirations  18  ;  respiration  difficult,  expiration  irregular.  Trem- 
bling attacks,  at  first  localised  in  the  crural  and  gluteal  muscles,  after- 
wards generalised  ;  signs  of  depression.  At  3.30  p.m.  more  abundant 
ptyalism  ;  spasmodic  contractions  of  the  jaws  ;  stamping  and  signs  of 
excitement  alternating  with  periods  of  depression  ;  passage  of  soft 
faeces ;   strong  and   persistent  borborygmus.     At  4  p.m.   temperature 


INTRA-VENOUS    INJECTIONS    OF    IODINE.  6ll 

38*4°  C. ;  pulse  39  ;  respirations  11  ;  ptyalism  and  trembling  continued  ; 
signs  of  depression  became  more  marked ;  fresh  passage  of  soft  excre- 
ment. At  5  p.m.  temperature  38'!°  C. ;  pulse  45;  respirations  13; 
passage  of  large  quantities  of  haemoglobinuric  urine ;  the  depression, 
salivation,  and  trembling  fits  were  diminishing.  At  6  p.m.  temperature 
38-4°  C. ;  pulse  47 ;  respirations  11 ;  still  a  few  trembling  movements. 
At  7  p.m.  temperature  38*4°  C. ;  pulse  52  ;  respirations  14.  The  animal 
seemed  to  have  resumed  its  normal  condition. 

(ii)  Horse,  weighing  594  lbs.,  received  at  i  p.m.  on  the  29th  March 
an  injection  into  the  jugular  vein  of  twenty-four  fluid  drachms  of  a  5 
per  cent,  iodine  solution  (containing  64*5  grains  of  iodine,  i.  e.  a  little 
less  than  •12  grain  per  pound  of  body-weight).  Before  the  injection 
temperature  38"i°  C.  At  the  end  of  three  minutes  defaecation ;  a 
quarter  of  an  hour  later  salivation,  attempts  to  vomit,  rapid  breathing ; 
twenty  minutes  later  excitement  and  signs  of  colic.  At  2  p.m.  pt3'alism 
continued,  and  the  animal  attempted  to  vomit ;  softened  faeces  were 
passed ;  temperature  38*5°  C.  From  the  second  to  the  fourth  hour 
trembling  and  signs  of  depression  ;  temperature  39'i°  to  39*8°  C.  At 
5  p.m.  passage  of  haemoglobinuric  urine.  After  6  p.m.  the  disturbance 
diminished.     There  was  no  after  complication. 

Introduced  into  the  blood-stream  in  doses  of  "007  grain  per  pound 
of  the  animal's  body-weight  {i.  e.  six  grains  for  a  horse  weighing 
880  lbs.),  with  the  addition  of  sufficient  iodide  to  dissolve  it,  iodine  is 
well  tolerated  and  produces  no  manifest  external  symptoms.  In  doses 
of  '014  grain  per  pound  (twelve  grains  for  a  horse  weighing  880  lbs.), 
whatever  the  degree  of  dilution,  it  usually  produces  more  or  less  pro- 
nounced symptoms,  depending  on  the  species  of  animal  and  on  its  in- 
dividual susceptibility,  symptoms  among  which  ptyalism,  trembling 
fits,  and  localised  convulsions  are  the  most  constant.  Injection  of 
larger  doses  is  only  justifiable  if  immediate  intense  action  is  necessary, 
if  the  doses  can  only  be  given  at  intervals  of  several  days,  or  can  only 
be  repeated  a  few  times. 

In  doses  of  '07  grain  (60  grains  for  a  horse  weighing  880  pounds), 
iodine  produces  grave  disturbance,  symptoms  of  hsemoglobinuria,  and 
very  frequently  renal  lesions  similar  to  those  of  haematuria. 

In  my  therapeutic  experiments  I  did  not  exceed  doses  of  7  to  30 
grains  per  day  according  to  the  weight  of  the  horse. 

According  to  some  authors  iodine  when  injected  into  the  blood  can 
have  no  useful  effect  because  it  combines  wdth  alkaline  substances.  It 
would,  therefore,  have  no  action  on  micro-organisms,  to  destroy  which 


6l2  CLINICAL    VETERINARY    MEDICINE    AND    SURGERY. 

such  large  quantities  would  be  required  as  to  cause  death  from  acute 
iodism.  In  attacking  the  microbe  one  would  destroy  the  cells  and  kill 
the  animal.  But  in  refutation  of  this  we  urge  that  iodine,  like  the 
iodides  and  other  antiseptics,  may  prove  valuable  in  toxi-infections 
without  actually  destroying  the  microbes.  Small  quantities  of  anti- 
septics and  other  chemical  agents  may  act  either  by  diminishing  the 
production  of  microbic  poisons,  by  assisting  in  their  destruction  by 
the  organs,  or  by  stimulating  the  emunctories ;  or  again,  by  exciting 
the  tissues  to  greater  action,  modifying  the  fluids  of  the  body,  and 
rendering  them  less  favourable  to  pathogenic  agents.  From  this  point 
of  view  intra-venous  injections  of  certain  antiseptics  seem  capable  of 
varied  apphcation.  Only  to  mention  one,  if  the  reported  cases  of 
recovery  from  glanders  after  intra-tracheal  injections  of  iodine  are 
authentic — I  especially  allude  to  those  of  Chelchowski  and  of  Neimann 
— intra-venous  injections  of  similar  solutions  deserve  trial  in  horses 
which  mallein  shows  to  be  suffering  from  internal  glanderous  lesions, 
and  which  sometimes  have  to  be  kept  under  observation  for  mouths. 
As  the  specific  lesions  from  which  they  suffer  often  end  by  spontaneously 
healing,  it  is  conceivable  that  one  might  assist  the  organism  in  its 
struggle  against  infection  and  help  it  to  emerge  triumphant. 

Many  other  drugs  may  also  be  given  intravenously  with  advantage ; 
thus  intravenous  injections  of  argentum  colloidale  Crede  in  doses  of  six 
to  twelve  grains  dissolved  in  ten  to  thirteen  fluid  drachms  of  water  have 
proved  of  remarkable  value  in  purpura  hsemorrhagica  of  the  horse 
(Dieckerhoff,  Meissner,  Kroning)  and  in  gangrenous  coryza  in  the  ox 
(Meissner,  Tannebring,  David). 

In  a  similar  way  chloride  of  barium  has  been  administered  to 
produce  rapid  evacuation  of  the  bowel  w^hen  treating  colic  in  the  horse. 
Despite  the  accidents  which  have  followed  administration  of  excessive 
doses,  or  in  which  the  animals  were  already  intoxicated  by  intestinal 
poisons,  many  practitioners  continue  its  use.  Syncope  is  avoided  by 
injecting  small  doses  at  intervals  of  fifteen  to  twenty  minutes,  as  I 
suggested  in  1897.  The  first  dose  injected  should  be  from  three  and  a 
half  to  nine  grains,  which  may  if  necessary  be  repeated  in  fifteen  to 
twenty  minutes. 

In  animals  intra-venous  injection  is  very  simple,  though  it  requires 
a  little  practice.  As  a  rule  the  substance  employed  is  very  active,  the 
quantity  of  liquid  injected  small,  and  no  special  instrument  necessary; 
a  syringe  of  six  fluid  drachms  capacity  and  a  needle  about  three  inches 


INTRA-VENOUS    INJECTIONS    OF    IODINE.  613 

in  length  being  alone  required.     In  large  animals,  and  even  in  the  dog, 
the  jugular  is  the  vessel  chosen. 

The  vein  is  compressed  at  its  lowest  point  until  it  becomes  distended 
and  prominent,  the  needle  is  then  introduced  obliquely  in  the  direction 
of  the  vessel,  the  further  wall  of  which  must  not  be  pierced  ;  the  skin 
is  drawn  slightly  towards  the  head,  and  the  needle  gently  passed  in 
succession  through  it,  the  subcutaneous  connective  tissue,  and  the  wall 
of  the  vein. 

Escape  of  blood  through  the  needle  shows  that  it  has  entered  the 
lumen  of  the  vein.  Should  any  doubt  exist  on  this  point — especially  if 
the  horse  has  struggled  meanwhile — the  vein  is  again  "raised"  for  an 
interval  of  a  few  seconds  and  blood  again  caused  to  escape  from  the 
needle.  The  latter  is  then  grasped  between  the  index  finger  and 
thumb,  the  nozzle  of  the  syringe  attached  to  it,  and  the  liquid  slowly 
injected. 

The  bore  of  the  needle  being  so  narrow,  passage  of  air  need  not  be 
feared,  though  even  should  a  few  small  bubbles  pass  into  the  vein  no 
bad  effects  follow. 


6i4 


APPENDIX. 


A   COMPARATIVE    table    showing    the    approximate   equivalent    in 
Fahrenheit's  scale  of  a  given  Centigrade  reading. 


INDEX. 


Abomasum,  ulceration  of      .         .         .  469 

Abscess,  cardiac    .....  365 

—  cold,  in  retro-pharyngeal  glands      .  ^^36 

—  of  liver    ......  376 

Acariasis,  symbiotic,  and  eczema  of  ear  312 

Acute  inguinal  hernia   ■         •         •         •  35 
Adenoma,  mammary,  with   pulmonary 

metastasis  .         .         .         .         -517 

Agoraphobia         .....  273 

Amenorrhcea          .....  424 
Amputation  of  penis                       .        56, 412 

Ansemia,  parasitic          ....  504 
Aneurismal  varix,  spermatic 

Aorta,  posterior,  rupture  of            .          .  386 

Aortic  insufficiency  in  the  horse    .         .  125 

Aponeurosis  of  flank,  necrosis  of           .  368 

"  Arterial  dance  "           ....  128 

Artery,  pulmonary,  rupture  of       .         .  366 

Ascites,  chylous,  in  a  cat       .         .         .  380 

Atrophy  of  penis  .....  414 

Auricles,  ossification  of          .         .         .  153 

Auricular  myocarditis  ....  150 

Avian  tuberculosis         ....  522 

—  —  summary  and  conclusions  .          .  554 
Azoturia 249 


B.\SEDOw's  disease 

Behring's  antitoxin  in  tetanus 

Blennorrhoea  in  the  dog 

Bothryomycosis     . 

Bradycardia 

Brain,  echinococcosis  of 

Britit  de  pot  fele 

Cachexi.\      .... 
Calculus,  urethral 


272 
501 
52 
477 
157 
504 
177,  192 

276 
■     414 


Cancer  of  inferior  maxilla 

—  of  kidney 

—  of  penis    . 

—  of  scrotum 

—  of  stomach 

—  of  superior  maxilla 

—  of  tail 287 

—  of  testicle 

Cancerous  intra-orbital  growth 
Cancroid,  pseudo-,  of  lip 
Canine  tuberculosis,  method  of  infection 

in        .         .         .         . 

—  —  origin  of      . 
Canker,  auricular 
"  Canker  "  of  the  foot    . 
Carcinoma  of  kidney    . 
Cardiac  abscess     . 

—  intermittency  in  the  horse 
"  Cardiac  heart " 

—  kidney  "  . 

—  liver  " 
Caries,  dental 
Carpal  sheath,  suppurating  synovitis  of 
Cataract,  operation  for . 

—  traumatic  .... 
Cerebral  haemorrhage    . 

—  injury  and  Cheyne-Stokes  respira 
tion    ...... 

Cerebrum,  tuberculosis  of 
Cervical  desmotomy 
Cheek,  papillary  sarcoma  of 
Cheyne-Stokes  respiration     . 
Chorea  .         .         .         .         • 

Chronic  myocarditis 

—  pharyngitis   .... 

—  pleurisy  in  the  horse 


PAGE 

328 

389 
410 

405 

374 

22 

,  427 
405 
310 

324 

241 
241 
287 
296 
517 
365 
157 
149 
136 
135 
>  330 

437 
312 

3" 

305 

307 
470 

341 
326 

307 
510 
151 
335 
202 


6i6 


INDEX. 


Chronic  roaring,  surgical  treatment  of  . 


Chylous  ascites  in  cat    . 

Cocco-bacille  typhiqiie    . 

Cold  abscess  in  retro-pharyngeal  glands 

Constipation 

Contagious  pneumonia  in  the  horse 

—  —  Schiitz's  organism  of . 
Corn,  complicated  cases  of   . 
"  Corrigan's  pulse" 
Cortical  or  partial  myocarditis 
Costal  region,  abscess  of 
"  Critical  abscesses  " 
Cryptorchid  operations 
Cyst,  hydatid,  of  heart 
Cystic  degeneration  of  ovary 
Cysts,  dentigerous 

—  sebaceous,  in  false  nostril 


Debris,  paradental  epithelial 
Degeneration,  cystic,  of  ovary 
Dental  caries 
—  fistula 
Dentigerous  cysts 
Desmotomy,  cervical    . 
Diabetes  mellitus  in  the  dog 
Diaphragmatic  hernia  . 
■ —  —   mechanism  of 
"  Discordant"  breathing 


Echinococcosis 
Eczema,  chronic 

—  in  the  dog 

—  in  the  horse 

—  rubrum     . 

—  seborrhceic 

Elbow,  penetrating  wound  of 
Endocarditis,  acute,  in  the  horse 

—  —  microbes  in 

—  chronic     . 

—  malignant,  ulcerative,  or  sept 

—  "  purring  murmur"  in 

—  vegetative  or  verrucous 
Epithelioma. 

—  of  vulva  . 
Exophthalmic  goitre     . 
External  tuberculosis  in  the  dog  and  cat 
Eyelid,  lower,  and  gjobe  of  eye,  tumour 

of      .         .         .         .         . 

Facial  sinuses,  epitheliomata  in  . 


30, 
347 
380 

188 

384 
185 
187 
455 
139 
151 
357 
192 

397 
364 
421 

1,  23 

•  316 

2,  28 

•  421 
8,330 

331 

i>  23 

341 

264 

44 

47 

204 


504 
286 
279 
291 
282 
284 
435 
"5 
118 

359 
120 
119 
120 

584 
424 

272 
100 

309 


Facial  sinuses,  fibrous  polypi  in     . 

—  —  mucous  cysts  in 

—  —  myxomata  in       .         .         . 

—  —  purulent  collections  in 

—  —  sarcomata  in        .         .         . 

—  —  tumours  in  .  .  . 
False  nostrils,  sebaceous  cysts  in  . 
Fehling's  test  for  sugar 
Fistula,  dental  .... 
Fistulous  withers  .... 
Flank,  necrosis  of  aponeurosis  of 
Flexor  brachii  muscle,  injury  of    . 

—  tendons,  rupture  of,  after  neurectomy 
P'pot,  granuloma  of       .         .         . 
Foreign  body  in  mouth 

—  —   in  oesophagus 

—  —  in  rectum    .... 
Fracture  of  humerus  in  a  horse     . 

—  of  lower  iaw     .... 


Gallinace^,  tuberculosis  in         .          .  523 

Gangrene,  moist,  of  neck       .          .          .  340 

Glanders,  treatment  of          .         .         .  600 

Globe  of  eye  and  eyelid,  tumour  of       .  309 

Glycosuria    .....     264,  269 

Goat,  experimental  tuberculosis  in        .  575 

Goitre,  exophthalmic    ....  272 

Granuloma,  infective    ....  519 

—  of  foot 457 

Graves'  disease     .....  272 

"  Grease  "......  295 

Gutta  percha  for  "  stopping  "  alveolar 

cavity  after  tooth  extraction      .         .  10 

Guttural  pouch,  operation  on         .          .  335 

H.^MOGLOBINURIA            ....  249 

—  experimental    .....  260 

—  nature  of  .....  258 
Hsemorrhage,  cerebral,  in  the  horse  .  305 
Hemiplegia  laryngis  ....  347 
Hepatisation  of  lung,  changes  in  .  178,  194 
Hernia,  diaphragmatic            .          .       44,  373 

—  inguinal    .....        35,  370 

—  ventral      ......  369 

Humerus,  fracture  of,  in  a  horse    .          .  434 

Hydatid  cyst  of  heart    ....  364 

Hydrotherapy  in  pneumonia           .          .  200 

Hydrothorax          .....  202 

Hydroxyl  as  dressing    ....  444 

Hyovertebrotomy          ....  335 

•  417 


I'AGE 
23 
23 
23 

8 
24 
22 
316 
271 
2Z^ 
354 
368 

433 

448 

457 
334 
345 
385 
434 
326 


25        Hysteria  in  a  mare 


INDEX. 


617 


Iliac  arteries,  thrombosis  of 
Impaction    of    the    caecum     following 

dental  caries 
Imperforate  vagina 
Infective  granuloma 
Inferior  maxilla,  cancer  of 

—  —  ostitis  of 
Influenza  in  the  horse,  abdominal  form 
Inguinal     abscess,    deep-seated,     after 

castration  .... 

—  hernia,  acute    . 
Insufficiency,  aortic,  in  the  horse 

—  mitral,  in  the  horse 
Intermittency,  cardiac  .         -157 
Intestine,  obstruction  of 

—  perforation  of 
Intra-orbital  growth,  cancerous 
Intra-pericardial  hssmorrhage 
Intra-venous  injection  of  iodine 
Iodine,  intra-venous  injection  of 

—  —  —   in  pneumonia 

Jugular  vein,  phlebitis  of    . 

Kelotomy    .... 
Kidney, cancer  of 
• —  carcinoma  of   . 
Knee,  foreign  body  in  . 
Knuckling  over  at  fetlock     . 

Lateral  ligament  of  pedal  joint,  ne 

crosis  of    . 
Lip,  pseudo-cancroid  of 
Liver,  abscess  of  . 

—  echinococcosis  of     . 

—  subcapsular  haemorrhage  of 
Lower  jaw,  fracture  of  . 
Lung,  sarcomatous  disease  of 
Lungs,  echinococcosis  of 
Luxation  of  patella 
Lymphangitis   and   multiple  abscesses 

due  to  staphylococci . 

—  suppurating 

Mallenders 
Mammary  adenoma 
Maxilla,  rodent  cancer  of 
Median  and  ulnar  neurectomy 

—  neurectomy 
Melanuria      .... 
Meningo-encephalitis     . 


PAGE 

423 

328 

327 
210 

40 

35 
125 
132 
361 

377 
378 
310 

36s 
607 
607 
495 

341 

37 
389 
S17 
436 
445 


449 
324 
376 
504 
379 
326 

515 
504 
438 

97 
444 

295 

517 

29 

92 

447 
254 
323 


Mitral  insufficiency 

Moist  gangrene  of  neck 

Myocarditis 

Myoma  of  oesophagus    . 

Myositis,  degenerative  . 

Myxoma  of  uterus 

Nasal  cartilage,  necrosis  of  . 

—  cavities,  tumours  in 

—  polypi       .... 

—  septum,  necrosis  of 

—  sinuses,  purulent  inflammatioi 
Neck,  foetid  abscess  in  . 

—  lacerated  wound  of 

—  moist  gangrene  of    . 

—  sinus  of    . 

—  wound  of  .         .         . 
Necrosis  of  cartilage  of  nostril 

—  of  lateral  ligament  of  pedal  jo 

—  of  nasal  septum 

—  of  scapula 

—  of  turbinated  bone   . 
Nephritis,  acute    . 
Neurectomy,  median     . 

—  plantar     . 
trophic  changes  after 

—  ulnar 

"  Nutmeg"  liver  . 
Nymphomania 


14 


of 


132 
340 
,  361 

358 
257 
423 

315 

319 

16 

314 
323 
347 
344 
340 
340 
338 
315 
449 
314 
430 
317 
388 

447 
86 

87 
92,447 
135 
416 


92 


Obstruction  of  intestine     .         .  377 

CEsophagus,  foreign  body  in          .          .  345 

—  myoma  of         ....         .  358 

Omasum,  inflammation  of    .         .         .  469 

Ossification  of  the  cardiac  auricles        .  153 

Ossifying  periosteal  sarcomaof  shoulder  429 

Ostitis  of  inferior  maxilla      .         .         .  327 

Othaematoma         .....  285 

Otitis,  suppurating  median  .         .         .  298 

Ovariotomy  ......  416 

Ovary,  cystic  degeneration  of        .         .421 

Pachymeningitis  ....  512 
Papillary  sarcoma  of  cheek  .  .  .  326 
Paradental  epithelial  debris  .  .  .  2,  28 
Paralysis  of  penis  .         .         .         .411 

Parasitic  anaemia .  "  .  .  .  .  504 
Paresis  of  hind  limbs  ....  570 
Parrots,  tuberculosis  of  .  .  .  558 
Patella,  luxation  of  ...  .  438 
Penis,  amputation  of,  in  the  horse        56,  412 


6i8 


INDEX. 


Penis,  atrophy  of 

—  cancer  of 

—  cancroids  of     . 

—  necrosis  of 

—  papillomata  of 

—  paralysis  of      .         .         .         -57 
Pericarditis,  "  dry  " 

—  hsemorrhagic  . 

—  in  the  dog 

—  rubbing  sound  in 

—  tapping  for 

—  tuberculous,  in  the  dog 
Pericardium,  foreign  body  in 
Perinaeum,  rupture  of    . 
Pharyngitis,  chronic 

—  due  to  strangles 
Phlebitis  of  jugular  vein 
Picked-up  nail,  operation  fo 

treatment  of 

Plantar  neurectomy 
Pleurisy,  chronic,  in  the  horse 
Pneumococcus 
Pneumonia   . 

—  Friedlander's  bacillus  of 

—  in  the  horse 

—  —  contagious 

—  intra-venous  injection  of  iodine  in 

—  quinine  in 

—  salt  solution  in 

—  sporadic,    fibrinous,     croupou 
pneumonia  afrigore . 

Poll-evil         ... 
Polydipsia     . 
Polyuria 

Popliteal  glands,  abscess  in 
Posterior  aorta,  rupture  of 
Prolapse  of  uterus 
Prolapsus  vaginae  in  a  mare 
Prostate,  diseased,  in  dog 
Pseudo-cancroid  of  lip 
Pulmonary  artery,  rupture  of 

—  gangrene 
Purpura  hsemorrhagica 

—  —  injection  of  normal  horse 


in 


the 


Purulent     collections 

sinuses 
—  inflammation  of  nasal  sinuses 

Quinine  in  pneumonia 
Quittor  .... 


facial 


414 

410 

56 

09 

56 

411 

167 

166 

162 

166 

169 

164 

365 
426 

335 
219 

341 
451 
78 
86 
202 
174 
480 
174 
170 
185 
495 
482 

493 

172 

339 
268 
268 

444 
386 
422 
418 
391 
324 
366 
177 
496 

497 


323 

482 
449 


Radial  paralysis  in  the  horse 
Rectum,  foreign  body  in 
Retro-pharyngeal  glands,  cold  abscess 


Rheumatism 

Rib,  fracture  of     . 

—  necrosis  of 

"  Rig  "  operations 

Right  ventricle,  rupture  of 

Roaring,    chronic,    surgical    treatment 

of 30.  347 

Rodent  cancer  of  maxilla      ...       29 


PAGE 

64 

38s 


336 
5" 
357 
357 
397 
366 


Sallenders  .... 

Salt  solution  in  pneumonia    . 
Sarcoma        ..... 

—  cutaneous  .... 

—  ossifying  periosteal,  of  shoulder 

—  papillary,  of  cheek   . 

—  round-celled,  of  testicle    . 
Sarcomatous  disease,  a  case  of 

—  —  of  lung  .... 
Scapula,  necrosis  of  .  .  . 
Scapulo-humeral  articulation,  disease  of 
Scirrhous  cord  .... 
Scrotum,  cancer  of  .  .  . 
Sebaceous  cysts  in  false  nostril 
Semi-tendinosus  muscle,  ossification  o 

tendon  of  . 
Serotherapy  in  pneumonia    . 
Serum      antityphique     in      contagious 

pneumonia  .... 

Serum    injections    in    purpura    hsemor 

rhagica       ..... 
Sesamoid  ligaments,  rupture  of 
Shoulder,  ossifying  periosteal  sarcoma  of 
Sinus  of  neck  .... 

Spavin  ..... 

—  nature  of  .... 

—  neurectomy  in  treatment  of 

—  treatment  of     . 
Spermatic  aneurismal  varix 
Stomach,  cancer  of        .         .         . 
"Stopping"      alveolar      cavity      after 

removal  of  tooth 
Superior  maxilla,  cancer  of  . 
Supernumerary  tooth  in  the    tempora 

region  ..... 

Suppurating  lymphangitis     . 
Symbiotic  acariasis  and  eczema  of  the 

ear     ....... 


295 
493 
585 
106 

429 
326 
516 
106 
515 
430 
432 
408 

405 
316 

442 
200 


497 
461 

429 

340 

445 

72 

76 

72 

408 

374 


298 
444 

312 


INDEX. 


619 


Synovitis,  suppurating,  of  carpal  sheath     437 

Tachycardia  ....  157,  272 
Tail,  cancer  of  ...  .  287,  427 
Tapping  the  chest  ....     207 

Temperature     table     (comparison     of 

Centigrade  and  Fahrenheit  scales)    .     613 
Tendon  sheaths  in  front  of  hock,  dis- 
tension of  .....     446 
Testicle,  cancer  of         ...         .     405 

—  round-celled  sarcoma  of  .  .  .516 
Tetanus         ......     498 

—  Behring's  antitoxin  in      .         .         .     501 

—  injection  of  salt  solution  in  .  .  499 
Thoracentesis  .....  207 
Thrombosis  of  iliac  arteries  .  .  .  387 
Tibia,  fracture  of  .  .  .  .  .  443 
Tongue,  section  of  ...  .  333 
Trachea,  rupture  of  ...  .  344 
Traumatic  cataract  .  .  -311 
Tubercle  lesions  in  pheasants  .     529 

in  fowls       .....     530 

Tuberculosis,  avian       ....     522 

—  comparative  frequency   of  thoracic 

and  abdominal  lesions  in  .         .  237,  244 

—  conveyance  from  man  to  parrot  .     566 

—  experimental,  in  the  goat          .  .     575 

—  external,  in  the  dog  and  cat  .  .  lOi 
lesions  of    .         .  -471 

—  in  the  cat         ....      244,  473 

—  —  mode  of  infection  in  .         .         .     247 

—  in  the  cow        .....     469 

—  in  the  dog         .....     234 

—  in  the  Gallinacea;     ....     523 

—  in  the  horse     ....      225,  463 

—  mammalian  and  avian,  relations  be- 
tween        ......     573 


Tuberculosis  of  cerebrum 

—  of  parrots         ..... 

—  pulmonary,  transmission  from  man 
to  cat  ...... 

—  transmission  from  man  to  paroquet 

—  treatment  of     . 

"  Tuberculous  septicaemia  "  . 
Tumour  of  eyelid  and  globe  of  eye 

—  of  vertebral  column 
Tumours  in  facial  sinuses 

—  in  nasal  cavities       .... 

—  malignant,  conclusions  regarding    . 

—  —  in  animals  ..... 

—  of  the  brain      .  .  .      300,  301 

—  of  the  cerebellum     .         .         .      303 
Turbinated  bone,  chronic  inflammation 

of 

disease  of,  in  the  horse 

mucous  degeneration  of  (Sand's 

disease) 
new  growths  on 

—  —  pus  in  necrosis  of 

Ulnar  neurectomy 
Urethral  calculus  . 
Urethrotomy  for  calculus 
Uterus,  myxoma  of 

—  prolapse  of 

Vagina,  imperforate     . 
Vanadine,  on  the  action  of 
Ventricle,  right,  rupture  of 
Vertebral  column,  tumour  of 
Vulva,  epithelioma  of    . 

Withers,  fistulous 
Wound  of  neck     . 


PACK 

470 

558 

475 
475 
595 
240 

309 

308 

22 

319 

593 

579 

i  304 

,  304 

317 
14 

17 
16 


447 

414 

415 
423 
422 

423 
604 
366 
308 
424 

354 
33& 


printed  by  adlard  and  son, 
jartholomew  close,  london,  e.c.,  and  20,  hanover  square,  w. 


